Videoassistierte thorakoskopische Chirurgie beim Thoraxtrauma

Video-assisted thoracoscopy (VATS) has a place in both diagnosis and treatment of blunt thoracic trauma. Thoracoscopy is indicated after trauma in the presence of intrathoracic hemorrhage, persisting pneumothorax, insufficiently drained hemothorax, chylothorax, and posttraumatic pleural empyema, and in some cases of diaphragmatic rupture and mediastinal injuries. The patient must be hemodynamically stable before VATS is performed, and it must also be possible to position the patient on one side and perform single-lung ventilation. It is absolutely mandatory to know what the contraindications to this procedure are and to take account of the general condition of the patient and the impact any other injuries might have. During the acute phase VATS allows surgical control of bleeding. In the case of lung injury a stapler can be used for resection, usually wedge resection. Evacuation of intrathoracic blood may prevent formation of pleural adhesions. For persistent pneumothorax pleurodesis is best performed by thoracoscopy. When VATS is performed after thoracic trauma there is a 2% complication rate, complications including transient hypoxemia, reversible cardiac arrhythmias, lung injury, bleeding in the chest wall, and intercostal neuralgia.