Video-assisted thoracoscopic surgery removal of a retained broken knife in the lung parenchyma: a case report and review of the literature
Ehsan Adib, Mohammad Vakili OjaroodBackground:
Intrathoracic retained foreign bodies, such as knives, are typically removed via thoracotomy, which is an invasive procedure. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive surgical procedure that can be a very good alternative to thoracotomy in selected patients. VATS is primarily used for the management and treatment of lung and pleural diseases, and VATS-assisted removal of intrathoracic retained foreign bodies has been reported in the limited literature to date.
Case description:
Our patient was a 32-year-old woman with no specific disease who, following a physical altercation, sustained multiple blows to the upper back with a fruit knife. With the last blow, the knife blade broke off from the handle and penetrated deep into the lung parenchyma in the right posterior hemithorax. The patient was referred to our hospital after 4 hours, and, considering the patient’s stable hemodynamics and multidisciplinary cooperation, it was decided to remove the retained knife blade via 3-port VATS. The operation lasted 45 minutes and was performed without any complications, and a knife blade measuring 10 × 1.2-cm was successfully removed from the posterior segment of the right lower lobe parenchyma without resection of the lung tissue. The patient was discharged without any complications on the ninth postoperative day, and subsequent follow-ups were uneventful.
Discussion and conclusion:
VATS as a minimally invasive technique can be a viable option as a primary approach in carefully selected, hemodynamically stable patients with accessible intrathoracic retained foreign bodies, when preoperative imaging does not reveal major cardiac or vascular injury, and when a suitably experienced center with immediate access to open conversion is available.