There are two thoracic surgery teams in our hospital. All thoracic surgeons receive similar training programmes and the operative equipment is the same. Patients with chest injuries admitted to our hospital were equally distributed to the two thoracic surgical teams. The first group comprised patients admitted on odd-numbered dates and the other group comprised patients admitted on even-numbered dates. The first group underwent thoracoscopy for treating pleural collections only by the ‘evacuation’ method. This method focuses on the management of pleural collections without repair of lung lesions. All patients underwent a tube thoracostomy at the ER and the incision was made along the anterior axillary line at the fifth intercostal space. A 0° angle, 10-mm thoracoscope was used. Another thoracostomy was made along the mid axillary line at the seventh intercostal space. Pleural effusion and blood clots were removed by suction tube, referred to as the evacuation procedure. This procedure focuses on adequate drainage and re-expansion of the collapsed lungs. After these processes were performed, two new chest tubes were placed; 32-Fr straight and curved chest tubes were usually used. Continuous suction of the chest tubes with −15 cmH2O was performed and they were removed when there was no air leakage or if the amount of drainage from the chest tube was <100 ml per day.
The second group underwent thoracoscopy that had small differences from the former, referred to as the ‘evacuation with suture-resection’ method. As for the first group, another thoracostomy was made at the seventh intercostal space along the mid axillary line. After this drainage, thorough inspection of the lung surface was done to look for lacerations noted at the previous chest CT, especially the lung surface attached to the site of fractured ribs. When these lesions were found under thoracoscopic vision, the previously used 10.5 mm 0° angle scope was changed to a 5 mm 0° angle thoracoscope. A 5-mm Endo-clinch grasper was applied parallel to the thoracoscope through the same site. When the lesions were checked again, both edges of the lacerated lung were grasped and repaired using an endoscopic auto-stapler (Specialist Surgical Product, Covidien Taiwan Limited) inserted through the previous thoracostomy (usually in the fifth intercostal space, anterior axillary line). As in the previous intervention for the first group, 32-Fr straight and curved chest tubes were placed.
All patients were admitted to the ICU postoperatively for close observation, with the duration of ventilator usage recorded. Patients were weaned off the ventilator when their vital signs were stable along with normal oximeter readings. The chest tubes were connected to continuous low-pressure suction and the volume of chest tube drainage was recorded daily. The chest tube was removed when the pleural effusion in the past 24 h amounted to <100 ml, without continuous air leakage. All patients enrolled were followed up at our outpatient clinics for 1 year.
The second group underwent thoracoscopy that had small differences from the former, referred to as the ‘evacuation with suture-resection’ method. As for the first group, another thoracostomy was made at the seventh intercostal space along the mid axillary line. After this drainage, thorough inspection of the lung surface was done to look for lacerations noted at the previous chest CT, especially the lung surface attached to the site of fractured ribs. When these lesions were found under thoracoscopic vision, the previously used 10.5 mm 0° angle scope was changed to a 5 mm 0° angle thoracoscope. A 5-mm Endo-clinch grasper was applied parallel to the thoracoscope through the same site. When the lesions were checked again, both edges of the lacerated lung were grasped and repaired using an endoscopic auto-stapler (Specialist Surgical Product, Covidien Taiwan Limited) inserted through the previous thoracostomy (usually in the fifth intercostal space, anterior axillary line). As in the previous intervention for the first group, 32-Fr straight and curved chest tubes were placed.
All patients were admitted to the ICU postoperatively for close observation, with the duration of ventilator usage recorded. Patients were weaned off the ventilator when their vital signs were stable along with normal oximeter readings. The chest tubes were connected to continuous low-pressure suction and the volume of chest tube drainage was recorded daily. The chest tube was removed when the pleural effusion in the past 24 h amounted to <100 ml, without continuous air leakage. All patients enrolled were followed up at our outpatient clinics for 1 year.