Name of the Procedure:

Thoracoscopy, surgical; with control of traumatic hemorrhage

Summary

Thoracoscopy is a minimally invasive surgical procedure used to diagnose and treat problems in the chest. During the procedure, a tiny camera called a thoracoscope is inserted into the chest through small incisions, allowing doctors to see inside the chest cavity. When performed for controlling traumatic hemorrhage, it involves identifying and stopping bleeding within the chest.

Purpose

This procedure addresses traumatic internal bleeding within the chest caused by injuries such as gunshot wounds, stab injuries, or severe blunt trauma. The primary goal is to locate the source of bleeding and control it to prevent further blood loss and complications.

Indications

• Symptoms such as chest pain, difficulty breathing, or signs of significant blood loss (e.g., low blood pressure, rapid heart rate)
• Imaging studies showing blood accumulation in the chest (hemothorax) or other indications of internal bleeding
• Trauma history with penetrating or severe blunt chest injuries

Preparation

• Patients are usually instructed to fast for at least 6-8 hours before the procedure.
• Pre-procedure blood tests, imaging studies such as X-rays or CT scans, and possibly an electrocardiogram (ECG) will be performed.
• Medications may be adjusted, and patients should inform their doctor of any blood thinners or other relevant medicines they are taking.

Procedure Description

1. The patient is placed under general anesthesia to ensure they are asleep and pain-free.
2. Small incisions are made in the chest wall.
3. A thoracoscope equipped with a camera is inserted through one of the incisions, allowing the surgeon to view the inside of the chest on a video monitor.
4. Additional instruments are introduced through other incisions to control the bleeding by suturing, cauterizing, or using sealants.
5. Once the bleeding is controlled, the instruments are removed, and the incisions are closed with sutures.

Duration

The procedure typically takes 1 to 3 hours, depending on the complexity and severity of the bleeding.

Setting

Thoracoscopy is usually performed in a hospital operating room.

Personnel

• Thoracic Surgeon
• Surgical Assistants or Nurses
• Anesthesiologist
• Operating Room Nurse

Risks and Complications

• Infection at the incision sites
• Bleeding
• Pneumothorax (collapsed lung)
• Adverse reactions to anesthesia
• Damage to surrounding organs and tissues

Benefits

The primary benefit is the control and cessation of internal bleeding, which is crucial to prevent shock or death. Other benefits include a minimally invasive approach, which generally results in less pain and quicker recovery compared to open surgery.

Recovery

• Post-procedure monitoring in the hospital, possibly in the intensive care unit (ICU)
• Pain management with medications
• Instructions may include avoiding heavy lifting, strenuous activity, and certain movements for several weeks
• Follow-up appointments to monitor healing and ensure no recurrence of bleeding

Alternatives

• Open thoracotomy (more invasive and involves a larger incision)
• Blood transfusions and supportive care without surgery, if the bleeding is not severe

Pros of Alternatives:

• Open thoracotomy allows for a broader view and access to the chest cavity.
• Non-surgical management might be suitable for less severe cases or high-risk surgical patients.

Cons of Alternatives:

• Open thoracotomy involves more postoperative pain and longer recovery.
• Non-surgical management may not adequately address significant bleeding.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, patients may experience discomfort or pain at the incision sites, which can be managed with painkillers. Patients are encouraged to perform deep breathing exercises to prevent lung complications and to follow the post-operative care team’s instructions for a smooth recovery.