A prospective trial of videothoracoscopy was conducted at an urban trauma center between February 1992 and February 1993 to determine the efficiency of this less invasive method of evaluation and treatment. Twenty-four consecutive patients with chest
trauma (penetrating, n = 22; blunt, n = 2) were examined thoracoscopically for clotted
hemothorax that otherwise would have been treated with
thoracotomy (n = 9), suspected diaphragmatic injury (n = 10), and continued
bleeding (n = 5). To ensure maximal exposure,
general anesthesia with a double-lumen endotracheal tube was used in each patient. Clotted
hemothorax was successfully evacuated in eight of nine patients (89%). Diaphragmatic
laceration was suspected in 10 patients (2 abnormal chest radiographs, 8 proximity
penetrating wounds) and confirmed thoracoscopically in 5. In four patients, diaphragmatic
lacerations were successfully repaired with thoracoscopic techniques. Five patients underwent thoracoscopy for continued
hemorrhage (greater than 1,500 mL per 24 hours) after tube
thoracostomy. Intercostal artery injury was confirmed in all patients, and
diathermy provided hemostasis in three patients without
thoracotomy. No complications occurred. These data suggest the following: (1) Videothoracoscopy is an accurate, safe, and minimally invasive method for the assessment of diaphragmatic
injuries, control of continued chest wall
bleeding, and early evacuation of clotted
hemothorax. (2) This technique should be used more frequently in patients with thoracic
trauma. (3) Technical advances may expand the therapeutic role of thoracoscopy.