title: Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review.
abstract: OBJECTIVE
  Trauma patients frequently have serious chest injuries. Retained hemothoraces and persistent pneumothoraces are among the most frequent complications of chest injuries which may lead to major, long-term morbidity and mortality if these complications are not recognized and treated appropriately. Video-assisted thoracoscopy (VATS) is a well-established technique in surgical practice. The usefulness of VATS for treatment of complications after chest trauma has been demonstrated by several authors. However, there is an ongoing debate about the optimal timing of VATS.
  
  
  METHODS
  A computerized search was conducted which yielded 450 studies reporting on the use of VATS for thoracic trauma. Eighteen of these studies were deemed relevant for this review. The quality of these studies was assessed using a check-list and the PRISMA guidelines. Outcome parameters were successful evacuation of the retained hemothorax or treatment of other complications as well as reduction of empyema rate, length of hospital stay, and hospital costs.
  
  
  RESULTS
  There was only one randomized trial and two prospective studies. Most studies report case series of institutional experiences. VATS was found to be very successful in evacuation of retained hemothoraces and seems to reduce the empyema rate subsequently. Furthermore, the length of hospital stay and costs can be drastically reduced with the early use of VATS.
  
  
  CONCLUSIONS
  Early VATS is an effective treatment for retained hemothoraces or other complications of chest trauma. We propose a clinical pathway, in which VATS is used as an early intervention in order to prevent serious complications such as empyemas or trapped lung.
authors.affiliation: Hiram C. Polk Jr. M.D. Department of Surgery and Price Institute of Surgical Research, University of Louisville School of Medicine, Louisville, KY 40292, USA.
authors.forename: Adrian T
authors.initials: AT
authors.lastname: Billeter
authors.forename: Devin
authors.initials: D
authors.lastname: Druen
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.forename: Jason W
authors.initials: JW
authors.lastname: Smith
authors.forename: William
authors.initials: W
authors.lastname: Wrightson
authors.forename: J David
authors.initials: JD
authors.lastname: Richardson
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics; D016724:Empyema, Pleural / Q000191:economics / Q000601:surgery; D005547:Foreign Bodies / Q000191:economics / Q000601:surgery; D006491:Hemothorax / Q000175:diagnosis / Q000191:economics / Q000601:surgery; D017721:Hospital Costs; D006801:Humans; D007431:Intraoperative Complications / Q000191:economics / Q000209:etiology / Q000601:surgery; D007902:Length of Stay / Q000191:economics; D011030:Pneumothorax / Q000175:diagnosis / Q000191:economics / Q000601:surgery; D013898:Thoracic Injuries / Q000175:diagnosis / Q000191:economics / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
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