Rib fractures are common chest trauma and have previously been performed under direct vision. In recent years, some authors have begun to experiment with thoracoscopic fracture fixation with very desirable results.
The possibility and rationality of thoracoscopic fixation of rib fractures lies in: first, the fracture site can be well exposed through the endoscope; secondly, the fracture can be fixed in the chest cavity; third, the recent rapid development of thoracoscopic technology has provided technical guarantees for intrathoracic fixation fractures; fourth, the instruments and materials for intrathoracic fixation have been developed and continuously improved.
Thoracoscopic fixation of rib fractures has the following advantages: (1) minimally invasive. Thoracoscopic technology itself is a minimally invasive technique, and if fracture fixation can be implemented with such a technique, large injuries can be avoided for open surgery, which is its most significant advantage; (2) aesthetics. When open surgery completes fracture fixation, a long incision is required, and a long and obvious scar will be left after the operation, which is very unsightly. The endoscope is only done through a very small incision, and the postoperative scar is not obvious; (3) it is easy to expose. Exposing the broken end of the rib from within the chest cavity does not require muscle removal and does not require traction, so the disclosure effect is more ideal; (4) High efficiency: When fracture fixation surgery is performed by thoracoscopy, other injuries in the chest cavity can be treated at the same time, so it is extremely efficient.
The advantages of performing fractures thoracoscopically are obvious, but like all other surgeries, the technique has some obvious drawbacks: (1) The technique is not very convenient. Since the fixed operation is done indirectly by instrument, it is relatively difficult compared to open surgery, and it requires rigorous training to complete the operation skillfully; (2) the cost of surgery is high. Due to the need for thoracoscopy and special materials and instruments, surgery will be additional and the total cost will be higher than open surgery; (3) fractures in special locations are difficult to manage. Due to the limitations of instruments and materials, some special parts are difficult to expose, and fracture fixation is more difficult; (4) some rib fractures cannot be fixed. Some special fractures, such as comminuted fractures, cannot be fixed under the microscope; (5) some fractures are not very firmly fixed. Due to defects in materials and instruments, some fractures are difficult to fix firmly; (6) operation is difficult. Compared with open surgery under direct vision, the operation under the endoscope is relatively difficult; (7) the operation is more cumbersome. Because of the operation involving the endoscope and special instruments, the operation is generally more cumbersome; (8) the material cannot be removed. So far, all the materials used for the fixation of endoscopic fractures cannot be removed, and patients have to carry such materials in the body for a long time. Although these materials do not necessarily affect the human body, they are a clear drawback.
Rib fracture surgery is a very old procedure that has not progressed much over the years. The advent of thoracoscopic technology has become the most exciting advancement. Although there are some defects at present, with the continuous deepening of the research and development of various materials and devices, with the continuous improvement of technology, this technology will inevitably become more and more practical. However, no technology is a one-size-fits-all technology and has limitations or adaptations. Choosing a suitable case for surgery will inevitably achieve good results. However, we must not rush to the top because of the new technology, otherwise it will not only have no good effect, but also bring about various problems.