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Emergency VATS for Hemopneumothorax and Diaphragm Repair After Stabbing

Monday, November 21, 2016

This video demonstrates video-assisted thoracoscopic surgery (VATS) procedure performed on a 16-year-old male who had been stabbed in the right lower chest. The knife caused a 2 cm wound, penetrating through the chest wall into lung and diaphragm. The patient was taken to his local hospital, where a chest drain was inserted to drain the hemopneumothorax. However, because of continued bleeding and shock, the patient was urgently transferred to the author’s center for emergency surgery. A VATS procedure was performed through the two pre-existing wounds (stab and chest drain) without extending them. The steps performed in the operation were: drainage of the hemothorax, arrest of the bleeding, sutured repair of the diaphragm, and stapling of the injured lung to close the air leak. He was also aggressively transfused blood. The drain was removed on the second post-operative day, and he was medically discharged three days after the surgery.


Dear Doctor Aman Coonar, Congratulations for your excellent work and your patient's recovery. I (perhaps mistakenly) thought that VATS procedure would be an contraindication in such a hypotensive patient and it would be more safe to perform an open operation. Have you any parametrs about your decision (e.g. the amount of blood in chest drainage unit or the level of the arterial pressure)? I thank you. Yours Sincerely, Nicholas Desimonas Consultant (Greek NHS) e-mail: University hospital of Larissa, Greece
Thanks for your kind comments. In this case he had been well resuscitated by the referring team and this continued into the operating room at our hospital. We are located in a rural situation so are used to intra-transfer ongoing resuscitation. During preparation and at the start the table his BP was always >90 systolic and HR 90-110. The anaesthetic team is very experienced in avoiding hypotension. Almost all our thoracic cases start as VATS and we can convert to fully open thoractomy in < 60s. I was with the patient from his arrival so could act quickly. If this was a 'salvage' situation I would not have undertaken VATS. Hope this helps and pleased to carry on the discussion on the +/- of the approach :)
Hi , Thanks for having a look. I know you are joking, but for those who may not know this was the surgical fleece left at the site of the intercostal injury. It will of course become fragmented and go away after a few weeks.

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