VIDEO ASSISTED THORACOSCOPIC SURGERY VERSUS INTRA-PLEURAL STREPTOKINASE INSTILLATION: A RANDOMIZED, CONTROLLED CLINICAL TRIAL FOR OPTIMUM TREATMENT OF POST-TRAUMATIC RETAINED HEMOTHORAX dranitasinghsurgery@gmail.com

 

VIDEO ASSISTED THORACOSCOPIC SURGERY VERSUS INTRA-PLEURAL STREPTOKINASE INSTILLATION: A RANDOMIZED, CONTROLLED CLINICAL TRIAL FOR OPTIMUM TREATMENT OF POST-TRAUMATIC RETAINED HEMOTHORAX

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Dr. Rahul Singh drrahulsingh58749@gmail.com Hind Medical College Lucknownow Anatomy Lucknow India

India

Oral or Poster

Video-Assisted Thoracoscopic Surgery (VATS) has emerged as a safe and effective alternative for the evacuation of retained hemothorax

This prospective, RCT conducted in Trauma Surgery Department KGMU, Lucknow enrolling 88 patients with retained hemothorax following initial ICD insertion. After randomization, patients were allocated either VATS or IPSI. Outcomes included radiologic resolution of hemothorax, procedure-related complications, hospital stay duration, and the need for further interventions.

RCT comparing VATS and IPS for retained hemothorax in trauma patients, 88 patients were enrolled and randomized. The mean age was 38.7 ± 11.4 years in the VATS group and 37.9 ± 10.9 years in the IPSI group. The male-to-female ratio was 35:9 in VATS and 33:11 in IPSI. Blunt trauma was the predominant mechanism in both groups (VATS: 39, IPSI: 40). VATS achieved a significantly higher rate of complete radiological resolution (93.2% vs. 70.5%, p=0.006). Mean hospital stay was shorter (6.1 ± 1.4 vs. 8.4 ± 2.2 days, p<0.001), as was ICD duration (3.8 ± 1.1 vs. 6.2 ± 1.6 days, p<0.001). Complication rates (6.8% vs. 20.5%, p=0.045) and re-intervention needs (4.5% vs. 18.2%, p=0.036) were lower in the VATS group. One mortality occurred in the IPSI group. VATS proved more effective and safer overall.

Minimally invasive techniques are revolutionizing trauma care by offering effective alternatives to open procedures. VATS stands out as the superior modality for retained hemothorax management, though IPSI retains a role in appropriately selected cases, especially in low-resource environments. Further large-scale studies are needed to refine patient selection and treatment protocols.