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Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer.
Ann Thorac Surg. 2013 Mar; 95(3):994-9.AT

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+Show Affiliations

Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan. yamashi1@fukuoka-u.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

23295043

Citation

Yamashita, Shin-Ichi, et al. "Totally Thoracoscopic Surgery and Troubleshooting for Bleeding in Non-small Cell Lung Cancer." The Annals of Thoracic Surgery, vol. 95, no. 3, 2013, pp. 994-9.
Yamashita S, Tokuishi K, Moroga T, et al. Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. Ann Thorac Surg. 2013;95(3):994-9.
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. The Annals of Thoracic Surgery, 95(3), 994-9. https://doi.org/10.1016/j.athoracsur.2012.11.005
Yamashita S, et al. Totally Thoracoscopic Surgery and Troubleshooting for Bleeding in Non-small Cell Lung Cancer. Ann Thorac Surg. 2013;95(3):994-9. PubMed PMID: 23295043.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer. AU - Yamashita,Shin-Ichi, AU - Tokuishi,Keita, AU - Moroga,Toshihiko, AU - Abe,Sosei, AU - Yamamoto,Kozo, AU - Miyahara,So, AU - Yoshida,Yasuhiro, AU - Yanagisawa,Jun, AU - Hamatake,Daisuke, AU - Hiratsuka,Masafumi, AU - Yoshinaga,Yasuteru, AU - Yamamoto,Satoshi, AU - Shiraishi,Takeshi, AU - Kawahara,Katsunobu, AU - Iwasakai,Akinori, Y1 - 2013/01/05/ PY - 2012/09/05/received PY - 2012/10/31/revised PY - 2012/11/06/accepted PY - 2013/1/9/entrez PY - 2013/1/9/pubmed PY - 2013/4/24/medline SP - 994 EP - 9 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 95 IS - 3 N2 - 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. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/23295043/Totally_thoracoscopic_surgery_and_troubleshooting_for_bleeding_in_non_small_cell_lung_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(12)02490-3 DB - PRIME DP - Unbound Medicine ER -