Background Traumatic tracheobronchial injury is a rare manifestation after blunt chest injury. The current standard treatment has wide spectrum from conservative treatment to open thoracotomy with repair airway regarding to severity of the disease. However, to the best of our knowledge, no one has reported airway repair in trauma using video-assisted thoracoscopic surgery (VATS) before. Hence, we describe the successful management and repair of a transected right main bronchus using VATS. Case Description A 43-year-old male patient presented with chest tightness after a traumatic blunt chest injury; a chest computed tomography revealed multiple rib fractures and suspected right main bronchus injury with large pneumomediastinum and subcutaneous emphysema. Although the current standard treatment is to perform open thoracotomy with tracheal repair, we performed VATS repair of right main bronchus in purpose to reduce the stress from tissue trauma and minimally invasive fashion. Emergency surgery was scheduled for injury repair, and the transected right main stem bronchus and mediastinum hematoma were intraoperatively identified. The right main bronchus was repaired using polypropylene 4-0 interrupted sutures under uniportal VATS and covered with pericardial fat pad tissue. After the surgery, the patient had no air leak from chest tube drainage and recovered well. The patient was performed diagnostic bronchoscopy to confirm the patent airway at day 3 then discharged 7 days after surgery and was doing well at a 1-month follow-up. Conclusions VATS repair is safe and feasible as an alternative approach to conventional thoracotomy approach in the treatment of traumatic tracheobronchial injury.

Introduction: Alveolar air leak is a common and troublesome complication after pulmonary resection because it can lead to longer hospital stay and chest tube drainage time. Aim: As fibrin sealants are useful in the management of alveolar air leaks, we evaluated their benefit in patients undergoing pulmonary resection. Material and methods: This retrospective study included patients who underwent pulmonary resection in our hospital between 2016 and 2021. We grouped patients on the basis of whether fibrin sealant was used during surgery and compared outcomes between those with (fibrin sealant group) and without (control group) sealant use after propensity score matching (1 : 1). Results: During the study period, 375 patients underwent pulmonary resection; of these, fibrin sealant was applied at the staple line in 107 patients (fibrin sealant group), whereas sealant was not used in 268 patients (control group). After propensity score matching (1 : 1), there were 95 patients in both groups. There were no differences between the two groups in duration of chest tube drainage (3 days vs. 3 days; p = 0.753) or length of hospital stay (5 days vs. 4 days; p = 0.499). However, the sealant group showed higher cost of hospitalization (USD 4,360 vs. 3,614; p < 0.001). Multivariate analysis for identifying risk factors of persistent air leak revealed that male sex and chronic obstructive pulmonary disease were associated. Conclusions: Our results indicate that application of fibrin sealant was not effective in reducing length of hospital stay, duration of chest drains or air leakage.

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Objective: The objective of this study was to present our experience with transradial left subclavian artery (LSA) embolization after thoracic endovascular aortic repair (TEVAR).Methods: In 2017, nine patients who had undergone TEVAR for aortic dissection or aneurysm underwent LSA embolization through radial access using a 4F sheath.Results: TEVAR was performed for type B aortic dissection (6/9 [67%]) or descending aneurysm (3/9 [33%]), with proximal landing zones at zone 0 (1/9 [11%]), zone 1 (1/9 [11%]), and zone 2 (7/9 [78%]). Repairs were done using Medtronic (Santa Rosa, Calif) Valiant (7/9 [78%]) and Gore TAG (W. L. Gore & Associates, Flagstaff, Ariz) grafts (2/9 [22%]). Equal numbers of patients had type I, II, and III arches (33% each), and three of nine (33%) had bovine arches. Average LSA size was 10.3 (1.3) mm. Most patients (8/9 [89%]) underwent carotid-subclavian bypass in the same setting as TEVAR. Eight patients (8/9 [89%]) had the coil embolization performed as a planned staged procedure. One patient (1/9 [11%]) presented at 480 days with a type II endoleak and underwent coil embolization of the LSA. All cases were done through a 4F sheath placed in the radial artery. Patients had an average of 5.6 (3.4) coils implanted. All coils used were from the Penumbra (Alameda, Calif) Ruby system (standards, softs, and Penumbra Occlusion Device packing). Technical success, defined as successful occlusion of the LSA, was 100%. Average time of procedure was 41.2 (14.6) minutes. Patients were observed for a median of 172 days. During this time, no patients had stroke, hand ischemia, myocardial infarction, retrograde type A dissection, graft migration, type IA endoleak, type II endoleak originating from the LSA, or need for further aortic reintervention. One patient, who had a history of cocaine and meth use, presented with an acute-on-chronic complicated type B aortic dissection, underwent coil embolization on postoperative day 5, and died suddenly that evening.Conclusions: Transradial LSA coil embolization through a 4F sheath is a safe and efficient procedure. Although more studies are needed with a larger number of patients, we are comfortable recommending this approach to all patients requiring LSA coiling after TEVAR.