Video-assisted thoracoscopic surgery versus open thoracotomy for thoracic trauma in hemodynamically stable patients: An updated systematic review and meta-analysis.

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) is increasingly used in thoracic trauma, yet high-certainty comparative evidence against thoracotomy remains limited. We updated the only prior comprehensive meta-analysis (Wu et al., 2015) and re-derived all estimates from source-verified study-level data.

METHODS

Six databases were searched through December 2025. Studies comparing VATS with thoracotomy in hemodynamically stable adult patients with thoracic trauma were eligible. Random-effects models with restricted maximum likelihood estimation and Knapp-Hartung adjustment were used; heterogeneity was assessed with I² and 95% prediction intervals (PI). PROSPERO CRD420261322930.

RESULTS

Thirty studies were included. VATS was associated with fewer postoperative complications (RR 0.56, 95% CI 0.42-0.74; I² = 0%), shorter hospital stay (MD -4.30 days, 95% CI -5.12 to -3.49), shorter operative time (MD -37.52 min, 95% CI -47.73 to -27.32), and less intraoperative blood loss (MD -119.09 mL, 95% CI -159.16 to -79.01). Perioperative mortality favoured VATS but was of borderline significance (RR 0.48, 95% CI 0.24-0.97; I² = 0%) and was not significant when the single dominant study was removed (RR 0.56, 95% CI 0.27-1.19). The pooled VATS-to-thoracotomy conversion rate was 13.0% (95% CI 5.9-26.2%). Prediction intervals excluded the null for complications and hospital stay but crossed it for operative time and blood loss. Effect sizes for complications and hospital stay were attenuated in contemporary studies.

CONCLUSIONS

In hemodynamically stable thoracic trauma patients, VATS is associated with fewer complications and a shorter hospital stay than thoracotomy; a mortality benefit was of borderline significance and dependent on a single study. The evidence derives exclusively from observational studies, predominantly single-centre Chinese cohorts, with attenuating effect sizes over time and very low certainty for all comparative outcomes. Multicentre prospective studies are warranted.

LEVEL OF EVIDENCE: IV.