Narrative review of VATS for traumatic diaphragmatic injuries: a minimally invasive approach to diagnosis and repair

Background and Objective: Traumatic diaphragm injury (TDI) is an important complication of thoracoabdominal trauma, that can lead to significant mortality when not promptly and effectively repaired. Video-assisted thoracoscopic surgery (VATS) is a valuable tool in TDI repair and identification, which has seen increasing use in the past few decades. This narrative review of the literature aims to summarise how a VATS approach can be used to repair a TDI and discuss its role as a diagnostic tool in the setting of trauma.

Methods: In February 2025, a keyword-based search of PubMed and Google Scholar was used, followed by citation tracking, to thoroughly search the literature for relevant papers. Papers were screened, then selected based on accessibility and relevance, before being read more thoroughly to extract the key findings presented in this review.

Key Content and Findings: A uniportal VATS technique, as described in this review, can be used to effectively repair TDI, especially in cases with small diaphragmatic injuries or when alternative approaches such as laparoscopy would be insufficient. Though CT imaging is very useful in the diagnosis of TDI, video-assisted thoracoscopy (VAT) is also important in assessing the diaphragm for injuries that may be missed on imaging. Both for diagnosis and treatment, there remains a lack of high-level evidence comparing thoracic and abdominal approaches, and it is unclear which is generally superior.

Conclusions: VAT and VATS are useful in diagnosis and treatment of TDI, and may be performed in place of abdominal approaches depending on the clinical details of the specific case. Until further research is conducted to directly clarify the factors influencing surgical approach, the decision to use VATS should depend on the surgeon’s expertise and the clinical context of each case.