With exhaustive work-ups of imaging studies, VATS has become a technically feasible scouting procedure. The use of video-assisted thoracoscopic surgery (VATS) has recently provided an alternative way to simultaneously diagnose and manage patients with thoracic trauma ( 6). A wide incision provides the surgeon excellent exposure and allows removal of the object under direct vision, as well as expeditious repair of associated vascular or visceral injuries. Traditionally, open thoracotomy has been the standard approach for the safe retrieval of an object impaled in the chest. However, patients who reach the hospital in a hemodynamically stable state might be considered to sustain injury that did not affect vital internal structures. Pre-hospital mortality rates are high owing to the involvement of the heart and great vessels. Penetrating trauma to the chest has significant on-scene mortality, directly related to the organs involved ( 5). After healthcare professionals provide basic life support to minimize blood loss and avoid further damage, the impaling object should be left in situ during patient transport if necessary, truncation should be performed beyond the edges of the skin. ( 4) introduced principles for the management of impalement injuries in 1995. Thoracic impalement injury is rare and among the most severe forms of thoracic trauma because of its high morbidity and mortality. Instead, injuries due to stabs and impalement occur more frequently. In contrast, gunshot-associated injuries are rare in Taiwan. The incidence of penetrating thoracic trauma associated with the use of firearms, stabbings, and impalement in urban trauma centers has been increasing, with the majority being secondary to gunshot wounds in North America ( 3). According to the literature, thoracic injuries account for approximately 25% of trauma-related deaths, with an estimated one-third of these mortalities being immediate because of injury severity ( 2). Trauma is the leading cause of death among those under the age of 45 in Taiwan ( 1).
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