Abstract

ANDRADE-ALEGRE, Rafael; PEREZ JIMENEZ, Gaspar  and  AVILA, Aldo. Rigid thoracoscopy in the management of clotted traumatic hemothorax. Rev. Inst. Nal. Enf. Resp. Mex. [online]. 2005, vol.18, n.3, pp.195-198. ISSN 0187-7585.

Introduction: Modern treatment of clotted traumatic hemothorax involves early evacuation and the use of minimally invasive techniques. The objective of this paper is to evaluate the results of rigid non-video thoracoscopy in the management of clotted traumatic hemothorax. Material and methods: In this prospective work, 15 consecutive patients, 13 men and 2 women, average age 25.5 years, were submitted to evacuation of a clotted traumatic hemothorax within 7 days or less of injury by means of rigid non-video thoracoscopy with a Carlens mediastinoscope through 1 or 2 one inch incisions under general anesthesia using a single lumen endotracheal tube. Results: Etiology were stab wounds in 9, gunshot wounds in 5 and blunt trauma in 1. Associated findings were diaphragmatic perforations in 3, hepatic laceration in 1 and pulmonary laceration in 1. An accessory incision was necessary in 4 cases, and 1 patient was converted to a limited thoracotomy due to technical difficulties. Average surgical time was 53.3 min. There was no mortality; one patient developed pneumoniae (6.6%). Average post-operative stay was 3.8 days. Estimated cost was 528 US dlls. Conclusions: Rigid non-video thoracoscopy using a Carlens mediastinoscope is an excellent method for the evacuation of clotted traumatic hemothorax with the advantages of simplicity of the equipment, diminished costs and the avoidance of double lumen endotracheal intubation. Rigid thoracoscopy should be considered in the management of short term, seven days or less, clotted traumatic hemothorax.

Keywords : Thoracic trauma; rigid thoracoscopy; videothoracoscopy; clotted traumatic hemothorax; mediastinoscope.