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A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy.
Surg Endosc 2013; 27(2):530-7SE

Abstract

BACKGROUND

Massive bleeding caused by vascular injury is considered the most troublesome and dangerous complication during video-assisted thoracoscopic surgery (VATS) pulmonary resection and is an important reason for emergency conversion to thoracotomy. The purpose of this paper was to show the suction-compressing angiorrhaphy technique (SCAT) for troubleshooting this problem without conversion.

METHODS

A total of 414 consecutive VATS anatomic pulmonary resections were performed between May 2006 and July 2011, among which 17 operations (4.11 %) encountered unexpected vascular injury. The procedure for troubleshooting vascular injury included bleeding control and angiorrhaphy. Bleeding was first controlled through side compression of the injured site with an endoscopic suction. Angiorrhaphy was then performed with running 5-0 Prolene suture using different procedures according to the size and location of the injuries, including direct suture upon suction compression, suture after substituting suction compression with clamping of the injured site, or suture after attaining proximal cross-clamping of the main pulmonary artery. Detailed information of these patients was carefully reviewed. The reasons for conversion to thoracotomy also were revealed.

RESULTS

Fifteen cases (15/17, 88.24 %) were successfully managed without conversion. Two cases of left main pulmonary artery injury were converted to thoracotomy due to difficulties in proximal cross-clamping of the injured vessel. Blood loss of the 17 patients ranged from 60-935 (median, 350) ml. Two patients were administered with allogeneic blood. The postoperative chest CT scan showed normal blood flow on the injured vessels. The total conversion rate was 2.66 % (11/414). The most common reason for conversion was hilar lymphadenopathy.

CONCLUSIONS

The SCAT is an effective procedure for managing vascular injury during VATS anatomic pulmonary resection. In most cases, bleeding control and angiorrhaphy could be achieved using this method with acceptable blood loss, thereby avoiding emergency conversion to thoracotomy.

Authors+Show Affiliations

Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22806532

Citation

Mei, Jiandong, et al. "A Novel Method for Troubleshooting Vascular Injury During Anatomic Thoracoscopic Pulmonary Resection Without Conversion to Thoracotomy." Surgical Endoscopy, vol. 27, no. 2, 2013, pp. 530-7.
Mei J, Pu Q, Liao H, et al. A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy. Surg Endosc. 2013;27(2):530-7.
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. Surgical Endoscopy, 27(2), pp. 530-7. doi:10.1007/s00464-012-2475-1.
Mei J, et al. A Novel Method for Troubleshooting Vascular Injury During Anatomic Thoracoscopic Pulmonary Resection Without Conversion to Thoracotomy. Surg Endosc. 2013;27(2):530-7. PubMed PMID: 22806532.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy. AU - Mei,Jiandong, AU - Pu,Qiang, AU - Liao,Hu, AU - Ma,Lin, AU - Zhu,Yunke, AU - Liu,Lunxu, Y1 - 2012/07/18/ PY - 2012/02/26/received PY - 2012/06/17/accepted PY - 2012/7/19/entrez PY - 2012/7/19/pubmed PY - 2013/8/13/medline SP - 530 EP - 7 JF - Surgical endoscopy JO - Surg Endosc VL - 27 IS - 2 N2 - BACKGROUND: Massive bleeding caused by vascular injury is considered the most troublesome and dangerous complication during video-assisted thoracoscopic surgery (VATS) pulmonary resection and is an important reason for emergency conversion to thoracotomy. The purpose of this paper was to show the suction-compressing angiorrhaphy technique (SCAT) for troubleshooting this problem without conversion. METHODS: A total of 414 consecutive VATS anatomic pulmonary resections were performed between May 2006 and July 2011, among which 17 operations (4.11 %) encountered unexpected vascular injury. The procedure for troubleshooting vascular injury included bleeding control and angiorrhaphy. Bleeding was first controlled through side compression of the injured site with an endoscopic suction. Angiorrhaphy was then performed with running 5-0 Prolene suture using different procedures according to the size and location of the injuries, including direct suture upon suction compression, suture after substituting suction compression with clamping of the injured site, or suture after attaining proximal cross-clamping of the main pulmonary artery. Detailed information of these patients was carefully reviewed. The reasons for conversion to thoracotomy also were revealed. RESULTS: Fifteen cases (15/17, 88.24 %) were successfully managed without conversion. Two cases of left main pulmonary artery injury were converted to thoracotomy due to difficulties in proximal cross-clamping of the injured vessel. Blood loss of the 17 patients ranged from 60-935 (median, 350) ml. Two patients were administered with allogeneic blood. The postoperative chest CT scan showed normal blood flow on the injured vessels. The total conversion rate was 2.66 % (11/414). The most common reason for conversion was hilar lymphadenopathy. CONCLUSIONS: The SCAT is an effective procedure for managing vascular injury during VATS anatomic pulmonary resection. In most cases, bleeding control and angiorrhaphy could be achieved using this method with acceptable blood loss, thereby avoiding emergency conversion to thoracotomy. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/22806532/A_novel_method_for_troubleshooting_vascular_injury_during_anatomic_thoracoscopic_pulmonary_resection_without_conversion_to_thoracotomy L2 - https://dx.doi.org/10.1007/s00464-012-2475-1 DB - PRIME DP - Unbound Medicine ER -