Skip to main content
SpringerLink
Log in

Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

SPVATS:

Single-port video-assisted thoracoscopic surgery

PET:

Positron emission tomography

CT:

Computed tomography

MRI:

Magnetic resonance imaging

EBUS-FNA:

Endobronchial ultrasound biopsy fine needle aspiration

References

  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):602–609

    Article  Google Scholar 

  2. Roviaro G, Rebuffat C, Varoli F, Vergani C, Mariani C, Maciocco M (1992) Videoendoscopic pulmonary lobectomy for cancer. Surg Laparosc Endosc 2:244–247

    CAS  PubMed  Google Scholar 

  3. Yan TD, Black D, Bannon PG, McCaughan BC (2009) Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol 27:2553–2562

    Article  PubMed  Google Scholar 

  4. McKenna RJ Jr, Houck W, Fuller CB (2006) Video-assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg 81:421–426

    Article  Google Scholar 

  5. Rueth NM, Andrade RS (2010) Is VATS lobectomy better: perioperatively, biologically and oncologically? Ann Thorac Surg 89(6):S2107–S2111

    Article  PubMed  Google 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):836–844

    Article  PubMed  Google 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):1037–1042

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rocco G, Martucci N, La Manna C (2013) Ten-year experience on 644 patients undergoing single-port (uniportal) video assisted thoracoscopic surgery. Ann Thorac Surg 96:434–438

    Article  PubMed  Google Scholar 

  9. Gonzalez-Rivas D, Paradela M, Fernandez R, Delgado M, Fieira E, Mendez L, Velasco C, de la Torre M (2013) Uniportal video-assisted thoracoscopic lobectomy: two years of experience. Ann Thorac Surg 95:426–432

    Article  Google Scholar 

  10. Wu CF, Gonzalez-Rivas D, Wen CT, Liu YH, Wu YC, Chao YK, Heish MJ, Wu CY, Chen WH (2015) Single-port video-assisted thoracoscopic mediastinal tumour resection. Interact Cardiovasc Thorac Surg 21(5):644–649

    Article  PubMed  Google Scholar 

  11. Shen Y, Wang H, Feng M, Xi Y, Tan L, Wang Q (2016) Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study. Eur J Cardiothorac Surg 49(Suppl 1):i48–i53

    PubMed  Google Scholar 

  12. Hsu PK, Lin WC, Chang YC, Chan ML, Wang BY, Liu CY, Huang WC, Shih CH, Liu CC (2015) Multiinstitutional analysis of single-port video-assisted thoracoscopic anatomical resection for primary lung cancer. Ann Thorac Surg 99(5):1739–1744

    Article  Google Scholar 

  13. Wu CF, Gonzalez-Rivas D, Wen CT, Liu YH, Wu YC, Chao YK, Hsieh MJ, Wu CY, Chen WH (2015) Comparative short-term clinical outcomes of mediastinum tumor excision performed by conventional VATS and single-port VATS: is it worthwhile? Medicine (Baltimore) 94(45):e1975

    Article  Google Scholar 

  14. Gonzalez-Rivas D, Stupnik T, Fernandez R, de la Torre M, Velasco C, Yang Y, Lee W, Jiang G (2016) Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgery. Eur J Cardiothorac Surg 49(Suppl 1):i17–i24

    PubMed  Google Scholar 

  15. Fernández Prado R, Fieira Costa E, Delgado Roel M, Fernández LM, Paradela de la Morena M, de la Torre M, Gonzalez-Rivas D (2014) Management of complications by uniportal video-assisted thoracoscopic surgery. J Thorac Dis 6(Suppl 6):S669–S673

    PubMed  PubMed Central  Google Scholar 

  16. Gonzalez-Rivas D, Fieira E, Mendez L, Garcia J (2012) Single-port video-assisted thoracoscopic anatomic segmentectomy and right upper lobectomy. Eur J Cardiothorac Surg 42(6):e169–e171

    Article  PubMed  Google Scholar 

  17. Gonzalez D, de la Torre M, Paradela M, Fernandez R, Delgado M, Garcia J, Fieira E, Mendez L (2011) Video-assisted thoracic surgery lobectomy: 3-year initial experience with 200 cases. Eur J Cardiothorac Surg 40(1):e21–e28

    Article  PubMed  Google Scholar 

  18. Cerfolio RJ, Bess KM, Wei B, Minnich DJ (2016) Incidence, results, and our current intraoperative technique to control major vascular injuries during minimally invasive robotic thoracic surgery. Ann Thorac Surg 102(2):394–399

    Article  PubMed  Google Scholar 

  19. Miyazaki T, Yamasaki N, Tsuchiya T, Matsumoto K, Hatachi G, Kitamura Y (2016) Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience. Surg Today 46(8):901–907

    Article  PubMed  Google 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):994–999

    Article  PubMed  Google Scholar 

  21. Mei J, Pu Q, Liao H, Ma L, Zhu Y, Liu L (2013) A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy. Surg Endosc 27(2):530–537

    Article  PubMed  Google Scholar 

  22. Augustin F, Maier HT, Weissenbacher A, Ng C, Lucciarini P, Öfner D, Ulmer H, Schmid T (2016) Causes, predictors and consequences of conversion from VATS to open lung lobectomy. Surg Endosc 30(6):2415–2421

    Article  PubMed  Google 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):1183–1187

    Article  PubMed  Google Scholar 

  24. Xie D, Wang H, Fei K, Chen C, Zhao D, Zhou X, Xie B, Jiang L, Chen Q, Song N, Dai J, Jiang G, Zhu Y (2016) Single-port video-assisted thoracic surgery in 1063 cases: a single-institution experience. Eur J Cardiothorac Surg 49(Suppl 1):i31–i36

    Article  PubMed  Google Scholar 

  25. Tam JK, Lim KS (2013) Total muscle-sparing uniportal video-assisted thoracoscopic surgery lobectomy. Ann Thorac Surg 96:1982–1987

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain

    Ching Feng Wu, Torre de la Mercedes, Ricardo Fernandez, Maria Delgado, Eva Fieira, Marina Paradela & Diego Gonzalez-Rivas

  2. Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain

    Ching Feng Wu, Torre de la Mercedes, Ricardo Fernandez, Maria Delgado, Eva Fieira, Marina Paradela & Diego Gonzalez-Rivas

  3. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan

    Ching Feng Wu, Ching Yang Wu, Ming Ju Hsieh, Yun Hen Liu & Yin Kai Chao

  4. Coruña University Hospital, Xubias 84, 15006, Coruña, Spain

    Diego Gonzalez-Rivas

Authors
  1. Ching Feng Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Torre de la Mercedes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricardo Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria Delgado
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eva Fieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ching Yang Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ming Ju Hsieh
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marina Paradela
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yun Hen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Yin Kai Chao
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Diego Gonzalez-Rivas
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Diego Gonzalez-Rivas.

Ethics declarations

Disclosures

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

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)

Supplementary material 3 (DOCX 112 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, C.F., de la Mercedes, T., Fernandez, R. et al. Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience. Surg Endosc 33, 1880–1889 (2019). https://doi.org/10.1007/s00464-018-6467-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6467-7

Keywords

Search

Navigation