H. Igai1, R. Yoshikawa1, F. Osawa1, T. Yazawa1, M. Kamiyoshihara1 1Japanese Red Cross Maebashi Hospital,Department Of General Thoracic Surgery,Maebashi, GUNMA, Japan
Introduction: Few studies have reported on the effects of intraoperative complications such as vessel injury during thoracoscopic anatomic pulmonary resections. We evaluated intraoperative vessel injury and assessed troubleshooting methods during thoracoscopic anatomic pulmonary resections.
Methods: Between April 2012 and March 2018, 378 patients underwent thoracoscopic anatomic pulmonary resection, 40 of whom were identified as having intraoperative vessel injury. Significant vessel injury was defined as bleeding that needed compression times of more than 30 seconds for hemostasis. In our department, we treat significant bleeding based on the algorithm shown in Figure 1. We analyzed the injured vessel and the hemostatic procedure employed, then compared the perioperative outcomes in patients with (n=40) or without (n=338) vessel injury. Additionally, we examined the data on a year-by-year basis from April 2012, and perioperative results were compared in each year.
Results: The surgical procedures examined included 32 lobectomies (80%) and 8 segmentectomies (20%). The vessel injured was a branch of the pulmonary artery in 22 cases (55%), a branch of the pulmonary vein in 13 (32.5%), and a different vessel in 5 (12.5%). The procedure was converted into a thoracotomy in five cases (12.5%) to achieve hemostasis. Hemostasis was achieved by applying a thrombostatic sealant in 26 cases (65%), compression with a cotton stick or adjacent lung parenchyma in 10 (25%), and some other way in 4 (10%).
Although patients without vessel injury had a shorter operation time (207 vs 240 min., p=0.0005), less intraoperative blood loss (53 vs 286ml., p<0.0001), and shorter duration of chest tube drainage (3 vs 3.9days, p=0.02), there were no significant differences in the length of postoperative hospitalization (8 vs 13days, p=0.14) or morbidity (15 vs 23%, p=0.25).
The occurrence rate of intraoperative significant bleeding in the last year measured was similar to that in the first year measured (6.8 vs 10.5%, p=0.23), although other perioperative results had significantly improved in that time frame.
Conclusion: Thoracoscopic anatomic pulmonary resection is feasible and safe if the surgeon performs appropriate hemostasis although vascular hazards might be inherent during thoracoscopic anatomic pulmonary resection, regardless of surgeon’s experience. Application of sealants and compression techniques using a cotton stick or adjacent lung parenchyma are important techniques to achieve hemostasis in the event of significant vessel injury during thoracoscopic anatomic pulmonary resection.
