Single port video-assisted thoracoscopic surgery for removal of a retained bullet in the lung parenchyma; A case report with literature review

For many years, thoracotomy has been considered as the standard approach for thoracic injuries. The aim of the current paper is to report a successful use of video assisted thoracoscopic surgery (VATS) as the first line approach for the removal of a bullet retained deep in the lung parenchymal tissue. A 46-year-old male presented with a vague pain in the chest at the site of a penetrating bullet injury 26 years prior. Chest and native chest Computed Tomography scan (CT scan) showed a 22 mm foreign body inside the substance of the left lower lobe in the anterior segment. Decision was made to remove the foreign body using VATS. The surgery was performed through an uni-port. The left lower lobe was explored and the foreign body was found within the anterior segment. It was removed and the defect was sutured using Vicryl 2/0. Although VATS has been established to be an accurate evaluating technique for direct evaluation of the chest wall, lung parenchyma, mediastinum and diaphragm, along with its effectiveness in successfully treating a variety of conditions, its use in thoracic trauma is still not well defined. This report supports the use of VATS as an effective and minimally invasive approach in the removal of foreign bodies in lung parenchyma. •Video-assisted thoracoscopic surgery (VATS) has been suggested as a lessor invasive procedure.•It's use in thoracic trauma remains controversial.•Loss of tactile sensation is a major obstacle.•In this report, removal of a retained bullet in the lung parenchyma using VATS has been discussed.