{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:22:22Z","timestamp":1785442942196,"version":"3.56.0"},"reference-count":46,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Zentralbl Chir"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>Seit Anfang der 90er-Jahre des letzten Jahrhunderts wird die videoassistierte Thorakoskopie (VATS) in zunehmendem Ma\u00dfe f\u00fcr eine Vielzahl von Indikationen in der Behandlung des Thoraxtraumas\n          eingesetzt. In dieser Zeit hat sich die Pr\u00e4misse f\u00fcr den Einsatz der Thorakoskopie nicht ge\u00e4ndert. Ihr Einsatz wird durchgehend nur f\u00fcr respiratorisch und kreislaufstabile Patient*innen mit\n          einem Thoraxtrauma empfohlen. Um die Indikationen der VATS f\u00fcr den Einsatz beim Thoraxtrauma zu definieren, hat die Unter-AG Lungenverletzung als Teil der interdisziplin\u00e4ren AG Thoraxtrauma\n          der Deutschen Gesellschaft f\u00fcr Thoraxchirurgie (DGT) und der Deutschen Gesellschaft f\u00fcr Unfallchirurgie (DGU) Behandlungsempfehlungen auf der Basis einer aktuellen Literaturrecherche\n          (angelehnt an die PRISMA-Checkliste\/hier: MEDLINE via PubMed von 1993 bis 2022) erarbeitet. In der vorliegenden Arbeit wurden nach Sichtung der recherchierten Literatur die Indikationen f\u00fcr\n          die VATS in der Versorgung des Thoraxtraumas identifiziert, um klinische Anwendungsempfehlungen f\u00fcr den Einsatz der VATS beim Thoraxtrauma zu formulieren. Nach der Analyse von 1679\n          gefundenen Literaturhinweisen verblieben insgesamt 4 randomisierte kontrollierte Studien (RCTs), 4 klinische Studien sowie 5 Metaanalysen oder systematische Reviews und 39 Reviews, die\n          aufgrund der geringen Evidenz der vorliegenden Literatur keinen h\u00f6heren Empfehlungsgrad als konsensuelle Empfehlungen erlauben. In den letzten 30 Jahren haben sich die\n          Stabilisierungsm\u00f6glichkeiten in der Versorgung von Traumapatient*innen deutlich verbessert, sodass die Indikationen zum Einsatz der VATS zunehmend erweitert werden konnten. Auch die seit\n          mehr als 50 Jahren bestehende Empfehlung, Traumapatient*innen bei einem initialen Blutverlust \u2265\u00a01500\u00a0ml \u00fcber die liegende Thoraxdrainage oder bei einem fortw\u00e4hrenden Blutverlust \u2265\u00a0250\u00a0ml\/h\n          \u00fcber 4\u00a0h zu thorakotomieren, hat sich mit den heutzutage besseren Stabilisierungsma\u00dfnahmen relativiert. F\u00fcr instabile\/nicht stabilisierbare Patient*innen mit einer notfallm\u00e4\u00dfig zu\n          versorgenden Thoraxverletzung ist die Thorakotomie weiterhin die Methode der Wahl, w\u00e4hrend die VATS in der Diagnostik und Therapie stabiler Patient*innen mit einem penetrierenden oder\n          stumpfen Thoraxtrauma f\u00fcr eine Vielzahl von Indikationen empfohlen wird. Indikationen f\u00fcr die VATS sind der persistierende H\u00e4matothorax, die Sanierung von Verletzungen und Blutungen an\n          Lunge, Zwerchfell, Thoraxwand und anderen Organverletzungen sowie in der Sekund\u00e4rphase die Therapie der thorakalen Verletzungsfolgen (Empyem, persistierende pulmonale Fistelung, infizierte\n          Atelektase etc.).<\/jats:p>","DOI":"10.1055\/a-1957-5511","type":"journal-article","created":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:41Z","timestamp":1670284841000},"page":"74-84","source":"Crossref","is-referenced-by-count":10,"title":["Videoassistierte Thorakoskopie (VATS) beim Thoraxtrauma"],"prefix":"10.1055","volume":"148","author":[{"given":"Christof","family":"Schreyer","sequence":"additional","affiliation":[{"name":"Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Eckermann","sequence":"additional","affiliation":[{"name":"Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus, Koblenz, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Neudecker","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Allgemein-, Viszeral-, Gef\u00e4\u00df- und Thoraxchirurgie, Universit\u00e4tsmedizin Berlin - Charit\u00e9 Campus Mitte, Berlin, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7876-2580","authenticated-orcid":false,"given":"Lars","family":"Becker","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Unfall-, Hand- und Wiederherstellungschirurgie, Universit\u00e4tsklinikum Essen, Essen, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schulz-Drost","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Unfallchirurgie und Traumatologie, HELIOS Kliniken Schwerin, Schwerin, Deutschland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,12,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1007\/s00068-019-01212-3","article-title":"Emergency department thoracotomy of severely injured patients: an analysis of the TraumaRegister DGU\u00ae","volume":"46","author":"S Schulz-Drost","year":"2020","journal-title":"Eur J Trauma Emerg Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3741426","DOI":"10.1155\/2016\/3741426","article-title":"Efficiency Analysis of Direct Video-Assisted Thoracoscopic Surgery in Elderly Patients with Blunt Traumatic Hemothorax without an Initial Thoracostomy","volume":"2016","author":"WY Huang","year":"2016","journal-title":"Biomed Res Int"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/s00423-012-1016-7","article-title":"Video-assisted thoracoscopy as an important tool for trauma surgeons: a systematic review","volume":"398","author":"AT Billeter","year":"2013","journal-title":"Langenbecks Arch Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.cjtee.2014.07.003","article-title":"Video-assisted thoracoscopic surgery for penetrating thoracic trauma","volume":"18","author":"J Jin","year":"2015","journal-title":"Chin J Traumatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.21037\/jtd.2019.03.55","article-title":"Video-assisted thoracoscopic surgery in trauma: pros and cons","volume":"11","author":"JV Lodhia","year":"2019","journal-title":"J Thorac Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1007\/s00268-014-2900-9","article-title":"A comparison of Video-Assisted Thoracoscopic Surgery with Open Thoracotomy for the Management of Chest Trauma: A Systematic Review and Metaanalysis","volume":"39","author":"N Wu","year":"2015","journal-title":"World J Surg"},{"key":"ref8","volume-title":"ATLS\u00ae Advanced Trauma Life Support Student Course Manual","author":"The Committee on Trauma 2018","year":"2018"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1016\/j.athoracsur.2006.09.082","article-title":"Video-assisted thoracoscopic surgery in the treatment of chest trauma: long-term benefit","volume":"83","author":"A Ben-Nun","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"117","DOI":"10.5505\/tjtes.2011.96777","article-title":"Should videothorascopic surgery be the first choice in isolated traumatic hemothorax? 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