Eighteen studies were included in the review (783 patients, range 11 to 139). There were two prospective studies, one of which was a randomised controlled trial (RCT); the other studies were case series. The authors stated that the quality of the included studies was variable. Sixteen studies had fewer than 100 participants.
Video-assisted thoracoscopy was successful with complete resolution in 87% of cases (range 75% to 100%). Overall conversion rate to open thoracotomy was 11% (range zero to 25%). The main complications were transient respiratory problems such as desaturation during video-assisted thoracoscopy, pneumonias (20%), atelectasis (13%) and operative incisional infections (6%). Most complications were minor and did not require operative intervention. Reoperation or secondary treatments were reported in approximately 17% of cases after video-assisted thoracoscopy. One study reported an empyema rate of 14% after video-assisted thoracoscopy for retained haemothoraces; it was unclear how many studies assessed this outcome but no other studies reported empyemas after evacuation of a retained haemothorax. The mortality rate was 1.4%; all studies reported that mortality was due to the trauma and not related to video-assisted thoracoscopy.
Results were reported on timing of video-assisted thoracoscopy, operative findings and types of injuries identified during video-assisted thoracoscopy and the impact of video-assisted thoracoscopy on hospital stays and costs.