Uniport versus Two-Port Video-Assisted Thoracoscopy in the Management of Retained Traumatic Hemothorax

Background: Traumatic hemothorax is the most common finding after chest trauma. Chest tube insertion is the primary management step. Retained hemothorax ranges from 5% to 30%. Various management strategies exist; observation is recommended for small amounts, whereas surgery is necessary for larger ones. Surgical intervention can be performed via thoracotomy or video-assisted thoracoscopy (VATS).Objectives: This study aims to compare between uniport and two-port technique VATS evacuation of retained clotted blood regarding safety and effectiveness.Patients and methods: This prospective study was performed in the Cardiothoracic Surgery Department at Menoufia University Hospital from June 2023 to December 2024. The study was conducted on 42 patients who presented with retained traumatic hemothorax managed by VATS.Results: This study included 42 patients who underwent VATS evacuation of retained hemothorax: single-port VATS in 26 patients and two-port VATS in 16 patients. The chest X-ray showed improvement in 24 cases in the uniport group and 10 cases in the two-port group, while residual haziness was noted in two cases in the uniport group and six cases in the two-port group, with statistically significant difference (FEp=0.038).Conclusion: Early evacuation of retained traumatic hemothorax via VATS is recommended. Both uniport and two-port VATS techniques yield mostly similar outcomes; however, we advocate for uniport VATS whenever possible, as it is less invasive for the patient.