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International expert consensus on the management of bleeding during VATS lung surgery.
Ann Transl Med. 2019 Dec; 7(23):712.AT

Abstract

Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.

Authors+Show Affiliations

Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.Department of Thoracic Surgery, Roswell Park Cancer Institute, Buffalo, NY, USA.Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100032, China.Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China. Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou 510120, China.Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China.Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming 650106, China.Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China.Department of Thoracic Surgery, First Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310003, China.Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China.Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China.Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China.Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China.Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China.Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China.Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, Shanghai 200003, China.Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China.Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.Department of Thoracic Surgery, Sun Yat-Sen University Cancer Center, Guangzhou 510060, China.Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China.Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China.Department of Thoracic Surgery, China and Japan Friendship Hospital, Beijing 100029, China.Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.Department of Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China.Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China.Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200032, China.Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China.Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China.Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China.Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China.Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.Department of Thoracic Surgery, The Second Hospital of Jilin University, Changchun 130041, China.Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.Thoracic Surgery Department, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain.Department of Thoracic Surgery, Asturias University Central Hospital, Oviedo, Spain.Department of Thoracic Surgery, University of Health Sciences, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.Division of Thoracic Surgery, Inselspital, University Hospital Bern, Bern, Switzerland.Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy.Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK.Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK.Department of Thoracic Surgery, Chang Gung Memorial Hospital (Linkou), Taiwan, China.Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.Department of Thoraco-abdominal Surgical Oncology. Herzen Moscow Cancer Research Center, Russia.Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.Honorary Consultant in Cardio-Thoracic Surgery, Gleneagles Hong Kong Hospital, Hong Kong, China.Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.Department of General Thoracic Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.Department of Thoracic Surgery, Thoracoscopic Surgery Center, New Tokyo Hospital, Chiba, Japan.Agasthian Thoracic Surgery Pte Ltd. 3 Mount Elizabeth #14-12 Mount Elizabeth Medical Centre, Singapore.Division of Thoracic Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.Moores Cancer Center, UC San Diego Health - La Jolla, Moores Cancer Center, La Jolla, USA.Division of Thoracic Surgery, Sun Yat-Sen Cancer Center, Taipei, Taiwan, China.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32042728

Citation

Liu, Lunxu, et al. "International Expert Consensus On the Management of Bleeding During VATS Lung Surgery." Annals of Translational Medicine, vol. 7, no. 23, 2019, p. 712.
Liu L, Mei J, He J, et al. International expert consensus on the management of bleeding during VATS lung surgery. Ann Transl Med. 2019;7(23):712.
Liu, L., Mei, J., He, J., Demmy, T. L., Gao, S., Li, S., He, J., Liu, Y., Huang, Y., Xu, S., Hu, J., Chen, L., Zhu, Y., Luo, Q., Mao, W., Tan, Q., Chen, C., Li, X., Zhang, Z., ... Liu, C. C. (2019). International expert consensus on the management of bleeding during VATS lung surgery. Annals of Translational Medicine, 7(23), 712. https://doi.org/10.21037/atm.2019.11.142
Liu L, et al. International Expert Consensus On the Management of Bleeding During VATS Lung Surgery. Ann Transl Med. 2019;7(23):712. PubMed PMID: 32042728.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - International expert consensus on the management of bleeding during VATS lung surgery. AU - Liu,Lunxu, AU - Mei,Jiandong, AU - He,Jie, AU - Demmy,Todd L, AU - Gao,Shugeng, AU - Li,Shanqing, AU - He,Jianxing, AU - Liu,Yang, AU - Huang,Yunchao, AU - Xu,Shidong, AU - Hu,Jian, AU - Chen,Liang, AU - Zhu,Yuming, AU - Luo,Qingquan, AU - Mao,Weimin, AU - Tan,Qunyou, AU - Chen,Chun, AU - Li,Xiaofei, AU - Zhang,Zhu, AU - Jiang,Gening, AU - Xu,Lin, AU - Zhang,Lanjun, AU - Fu,Jianhua, AU - Li,Hui, AU - Wang,Qun, AU - Liu,Deruo, AU - Tan,Lijie, AU - Zhou,Qinghua, AU - Fu,Xiangning, AU - Jiang,Zhongmin, AU - Chen,Haiquan, AU - Fang,Wentao, AU - Zhang,Xun, AU - Li,Yin, AU - Tong,Ti, AU - Yu,Zhentao, AU - Liu,Yongyu, AU - Zhi,Xiuyi, AU - Yan,Tiansheng, AU - Zhang,Xingyi, AU - Pu,Qiang, AU - Che,Guowei, AU - Lin,Yidan, AU - Ma,Lin, AU - Embun,Raul, AU - Aragón,Javier, AU - Evman,Serdar, AU - Kocher,Gregor J, AU - Bertolaccini,Luca, AU - Brunelli,Alessandro, AU - Gonzalez-Rivas,Diego, AU - Dunning,Joel, AU - Liu,Hui-Ping, AU - Swanson,Scott J, AU - Borisovich,Ryabov Andrey, AU - Sarkaria,Inderpal S, AU - Sihoe,Alan Dart Loon, AU - Nagayasu,Takeshi, AU - Miyazaki,Takuro, AU - Chida,Masayuki, AU - Kohno,Tadasu, AU - Thirugnanam,Agasthian, AU - Soukiasian,Harmic J, AU - Onaitis,Mark W, AU - Liu,Chia-Chuan, AU - ,, PY - 2020/2/12/entrez PY - 2020/2/12/pubmed PY - 2020/2/12/medline KW - Video-assisted thoracic surgery (VATS) KW - expert consensus KW - hemorrhage KW - pulmonary resection SP - 712 EP - 712 JF - Annals of translational medicine JO - Ann Transl Med VL - 7 IS - 23 N2 - Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful. SN - 2305-5839 UR - https://www.unboundmedicine.com/medline/citation/32042728/International_expert_consensus_on_the_management_of_bleeding_during_VATS_lung_surgery L2 - https://doi.org/10.21037/atm.2019.11.142 DB - PRIME DP - Unbound Medicine ER -
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