A tip for controlling the main pulmonary artery during video-assisted thoracic major pulmonary resection: the outside-field vascular clamping technique

Kamiyoshihara, Mitsuhiro; Nagashima, Toshiteru; Igarashi, Takashi; Takeyoshi, Isumi

doi:10.1510/icvts.2010.246132

Cited by 26 publications

(20 citation statements)

References 9 publications

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“…There are several other techniques [9,19] for controlling intraoperative bleeding without the need for conversion to thoracotomy. Mei et al [9] reported the suction-compressing angiorrhaphy technique for VATS.…”

Section: Discussionmentioning

confidence: 99%

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Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience

et al. 2015

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Section: Discussionmentioning

confidence: 99%

“…In their study, 88 % of cases were successfully managed without conversion. Kamiyoshihara et al [19] also reported controlling the main PA by using the out-of-field vascular clamping technique. These techniques were excellent, but difficult and impractical for all surgeons and trainees.…”

Section: Discussionmentioning

confidence: 99%

Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience

et al. 2015

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“…Distal control occasionally can be obtained directly on the artery or vein of interest, but generally is performed at the level of the pulmonary veins, and can also be performed intrapericardial if needed. Minimally invasive vascular control of the pulmonary artery with suture, clamps, or vessel loops has been described and may be considered dependent on the experience of the surgeon (39)(40)(41)(42).…”

Section: Surgical Prevention and Management Techniquesmentioning

confidence: 99%

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Safdie¹,

Sanchez²,

Sarkaria³

2017

J. Vis. Surg.

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Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/ or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injuryspecific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches. hemorrhage within moments. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. When they do occur, premeditated and expedited intervention is the key to rescue (1). The current report focuses on the prevention and management of these emergency bleeding events in VATS pulmonary resections. Preoperative radiologic assessment of vascular and anatomic variationRigorous preoperative evaluation of fitness of surgery is a key component of any operative assessment. Preoperative identification and awareness of case-specific and patientspecific risk factors may help prevent hemorrhagic complications in most lung resections. These factors include body habitus, preoperative chemotherapy and radiation, bleeding diatheses including medical anticoagulants, previous thoracic surgery, lymph node calcification and/or granulomatous disease, tumor size and location.Computed chest tomography has become a standard of care in virtually all cases considered for major pulmonary resection. These high resolution scans, often available with three dimensional reconstruction, can provide valuable opportunities to identify standard and anomalous vascular variations prior to surgery in greater than 95% of cases (2-6). Imaging may also identify cal...

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“…2-4). [61][62][63][64] Once bleeding is under control, assessment of the injury will determine the type of repair. The need for conversion should be considered early in minimally invasive operations.…”

Section: Surgical Techniquementioning

confidence: 99%

Great Vessel Injury in Thoracic Surgery

Villa

Sarkaria

2015

Thoracic Surgery Clinics

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A tip for controlling the main pulmonary artery during video-assisted thoracic major pulmonary resection: the outside-field vascular clamping technique

Cited by 26 publications

References 9 publications

Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience

Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion

Great Vessel Injury in Thoracic Surgery

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