title: Introducing video-assisted thoracoscopy for trauma into a South African township hospital.
abstract: BACKGROUND
  The use of video-assisted thoracoscopic surgery (VATS) is well established in trauma practice. This modality is readily available to centers with well-equipped operating facilities but may be challenging to introduce into resource-constrained institutions such as many South African township hospitals. We implemented VATS for retained post-traumatic pleural collections in our institution in 2007, and we have now performed an audit of the first 3 years of our experience.
  
  
  METHODS
  A retrospective chart review was conducted of all patients who had undergone VATS from June 2007 to May 2010, and statistical analysis was performed to elucidate the findings.
  
  
  RESULTS
  Forty-three patients were examined, 40 of whom (93 %) were male. The mean age was 32 years (range: 15-52 years). Thirty-five patients (81 %) had stab injuries, 6 (14 %) had blunt injuries, and 2 (4 %) had gunshot wounds. Mean time from injury to VATS was 12.4 days (range: 3-31 days). Thirteen patients (30 %) had empyema at the time of VATS. The mean time from VATS to discharge was 9 days (range: 3-30 days). The postoperative complication rate was 14 % and included pneumonia (n = 3) and re-collections (n = 3, two of which were managed by reinsertion of a chest drain, and one cleared without further intervention). Further analysis revealed a longer postoperative length of stay when empyema was present at VATS (8 days for no empyema vs. 11 days when empyema was present; p = 0.027). The incidence of empyema increased progressively the longer the delay between injury and VATS (0 % for VATS performed in week 1, 32 % for VATS in week 2, 50 % for VATS in week 3, and 60 % for VATS beyond week 3; p = 0.019). The incidence of empyema increased when >1 chest drain was inserted prior to VATS (15 % for 0-1 chest drain vs. 43 % for >1 chest drain; p = 0.043).
  
  
  CONCLUSIONS
  Introducing VATS for retained post-traumatic collections into a relatively resource-constrained township hospital in South Africa is safe and effective. Consideration should be given to performing VATS early and avoiding the use of a second and third chest drain for retained collections. This approach may lead to decreased incidence of empyema and shorter overall hospital stay.
authors.affiliation: Edendale Hospital, University of KwaZulu Natal, Private Bag X9001, Pietermaritzburg 3200, South Africa. george.oosthuizen@kznhealth.gov.za
authors.forename: George V
authors.initials: GV
authors.lastname: Oosthuizen
authors.forename: Damian L
authors.initials: DL
authors.lastname: Clarke
authors.forename: Grant L
authors.initials: GL
authors.lastname: Laing
authors.forename: John
authors.initials: J
authors.lastname: Bruce
authors.forename: Victor Y
authors.initials: VY
authors.lastname: Kong
authors.forename: Nadia
authors.initials: N
authors.lastname: Van Staden
authors.forename: David J J
authors.initials: DJ
authors.lastname: Muckart
mesh_terms: D000293:Adolescent; D000328:Adult; D003906:Developing Countries; D016724:Empyema, Pleural / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013019:South Africa; D013898:Thoracic Injuries / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D014951:Wounds, Stab / Q000601:surgery*; D055815:Young Adult