Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer.

Abstract

BACKGROUND:

Although accumulating data support the feasibility and efficacy of video-assisted thoracic surgery anatomic resection, few studies have reported on intraoperative complications, such as vessel injury. The purpose of this study was to evaluate intraoperative vessel injury and to analyze troubleshooting.

METHODS:

Twenty-six of 557 patients with non-small cell lung cancer who underwent thoracoscopic anatomic lung resection were identified as having intraoperative vessel injury between January 2004 and December 2011. The injured portion, devices used, recovery approach, and hemostatic procedure were analyzed. The perioperative outcomes in patients with and without vessel injury were compared.

RESULTS:

The most commonly used devices were ultrasonic coagulation shears in 9 cases, followed by scissors in 5 and an endostapler in 4. Seventeen of the 26 cases were injured at the branches of the pulmonary artery, and the others were at major vessels. Half of the patients were converted to thoracotomy, and 6 were treated by minithoracotomy. Hemostatic procedures were primary closure in 17 and sealant in 7. The perioperative outcomes, including operative time and blood loss, were significantly different between the two groups, but duration of chest tube drainage, length of hospital stay, and morbidity rate were not. No mortality was identified in the patients with vessel injury.

CONCLUSIONS:

Video-assisted thoracic surgery anatomic resection was feasible and safe, regardless of the intraoperative vessel injury. Although surgeons should pay attention to avoid unexpected bleeding, the magnitude of injury and effectual step-by-step management should lead to a safe operation.

• Authors: Shin-Ichi Yamashita, Keita Tokuishi, Toshihiko Moroga, Sosei Abe, Kozo Yamamoto, So Miyahara, Yasuhiro Yoshida, Jun Yanagisawa, Daisuke Hamatake, Masafumi Hiratsuka, Yasuteru Yoshinaga, Satoshi Yamamoto, Takeshi Shiraishi, Katsunobu Kawahara, Akinori Iwasakai
• Journal: The Annals of thoracic surgery (Ann Thorac Surg) Vol. 95 Issue 3 Pg. 994-9 (Mar 2013) ISSN: 1552-6259 [Electronic] Netherlands
• PMID: 23295043 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Blood Loss, Surgical (mortality, prevention & control)
• Carcinoma, Non-Small-Cell Lung (mortality, surgery)
• Feasibility Studies
• Female
• Humans
• Japan (epidemiology)
• Lung Neoplasms (mortality, surgery)
• Male
• Middle Aged
• Pneumonectomy (methods)
• Retrospective Studies
• Survival Rate (trends)
• Thoracic Surgery, Video-Assisted (methods)