Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience
Our objective is to report on two centers’ experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis.
Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury.
There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424–13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577–15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity.
In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
KeywordsSingle-port VATS Complications Bleeding episodes Risk factor analysis Management
Single-port video-assisted thoracoscopic surgery
Positron emission tomography
Magnetic resonance imaging
Endobronchial ultrasound biopsy fine needle aspiration
Study conception and design: CFW, DG-R, TM, RF, CYW. Acquisition of data: CFW, TM, RF, MD, EF, CYW, MJH, MP, YHL, YKC, DG-R. Analysis and interpretation of data: CFW, MD, CYW. Drafting of manuscript: CFW, TM, RF, DG-R. Critical revision: CFW, TM, DG-R.
Compliance with ethical standards
Ching Feng Wu, de la Torre Mercedes, Ricardo Fernandez, Maria Delgado, Eva Fieira, Ching Yang Wu, Ming Ju Hsieh, Marina Paradela, Yun Hen Liu, Yin Kai Chao, and Diego Gonzalez-Rivas have no conflicts of interest or financial ties to disclose.
Video 1: Unexpected superior segmental artery injury occurred during dissection of superior segmentectomy artery. Supplementary material 1 (MP4 270060 KB)
Video 2: Repaired oozing staple line with suture. Supplementary material 2 (MP4 169788 KB)
- 1.Falcoz PE, Puyraveau M, Thomas PA, Decaluwe H, Hürtgen M, Petersen RH, Hansen H, Brunelli A, ESTS Database Committee and ESTS Minimally Invasive Interest Group (2016) Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database. Eur J Cardiothorac Surg 49(2):602–609CrossRefGoogle Scholar
- 6.Bendixen M, Jørgensen OD, Kronborg C, Andersen C, Licht PB (2016) Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol 17(6):836–844CrossRefPubMedGoogle Scholar
- 7.Yang CF, Sun Z, Speicher PJ, Saud SM, Gulack BC, Hartwig MG, Harpole DH Jr, Onaitis MW, Tong BC, D’Amico TA, Berry MF (2016) Use and outcomes of minimally invasive lobectomy for stage i non-small cell lung cancer in the national cancer data base. Ann Thorac Surg 101(3):1037–1042CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Yamashita S, Tokuishi K, Moroga T, Abe S, Yamamoto K, Miyahara S, Yoshida Y, Yanagisawa J, Hamatake D, Hiratsuka M, Yoshinaga Y, Yamamoto S, Shiraishi T, Kawahara K, Iwasakai A (2013) Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. Ann Thorac Surg 95(3):994–999CrossRefPubMedGoogle Scholar
- 23.Martin-Ucar AE, Aragon J, Bolufer Nadal S, Galvez Munoz C, Luo Q, Perez Mendez I, Sihoe ADL, Socci L (2017) The influence of prior multiport experience on the learning curve for single-port thoracoscopic lobectomy: a multicentre comparative study. Eur J Cardiothorac Surg 51(6):1183–1187CrossRefPubMedGoogle Scholar