Introduction Video assisted thoracoscopy (VAT) has acquired specific indications in some cases representing the surgical standard (VATS), but its role in chest trau- mas remains controversial. Our group, in a prelimi- nary study, proposed the use of VAT in thoracic injury (5). Such approach is practicable in patients who do not present an imposing politrauma or critical condi- tions, and are in a state of consciousness and circula- tory stability. Ideal situations are hemothorax and he- mopneumothorax, besides piercing wounds resulting from firearms and knives. The advantages of vi- deothoracoscopy treatment in hemothorax compa- red to classic drainage-and-waiting are to be ascribed over all due to the immediacy of the possible passage from a diagnostic thoracoscopy to the operative tho- racoscopy realizing a hemostasis of minimum or in- tense hemorrhaging. On the other hand, even in ca- ses in which it might not be necessary to proceed to hemostasis, VAT obtains the result of evacuating the pleural cavity completely of clots present, thus pre- venting morbidity due to fibrothorax and empyema. Tube thoracostomy, which can be in itself the defini- tive treatment in chest injury, has a 2-30% incidence of retaining clots, requiring further intervention for cleaning (12, 4). The aim of this study is to delinea- te in a precise way the diagnostic and therapeutic ro- le of videothoracoscopy in thoracic trauma and to evaluate its efficacy. Video assisted thoracoscopy in thoracic injury: early or delayed indication? Duilio Div isi*, Carmelo Battaglia*, Berardo De Berardis**, M auriz io Vaccarili*, William Di Francescantonio*, Salv atore Salv emini*, R oberto Crisci* * Department of Thoracic Surgery, University of L’Aquila - “G. Mazzini” H ospital, Piazza Italia 1, 64100 Teramo (Italy). **Department of General Surgery, “G. Mazzini” H ospital, Piazza Italia 1, 64100 Teramo (Italy). Abstract. The aim of this study was to evaluate the diagnostic role and therapeutic effectiveness of videotho- racoscopy in chest trauma. Between 1 st January 1993 and 30 th September 2003, 112 traumatized patients un- derwent a videothoracoscopy. The origin of trauma was different : 60 road accidents, 42 accidental falls, 7 knife wounds and 3 firearm wounds. Seventy-six patients presented hemothorax, 21 hemopneumothorax, 10 sus- pected diaphragmatic injury and 5 pericardium effusion. All patients were hemodynamically stable and con- scious. In suspected diaphragmatic rupture patients, videothoracoscopy confirmed the presence of 4 lesions with diameter from 7 to 10cm. The etiopathogenetic causes in the other clinical patterns were: 20 lung lacer- ations, 17 apical adhesion lacerations, 11 diaphragmatic lesions, 16 wall bleedings and 38 vessel lesions. Nine- ty patients (80.3%) were treated with video assisted thoracic surgery. The remaining procedures were : 17 drainage tube insertions, 4 thoracotomies and 1 laparotomy. Videothoracoscopy made the use of the primary intention drainage tube obsolete in stable traumatized patients with hemothorax or hemopneumothorax. It is a safe technique that allows the diagnostic and surgical management of the lesions. Key words: Chest trauma, hemothorax, hemopneumothorax, diaphragmatic injury; video assisted thoracic surgery O R I G I N A L A R T I C L E ACTA BIO MEDICA ATENEO PARMENSE 2004; 75; 158-163 © ATTIOLI 885