Totally Thoracoscopic Surgery and Troubleshooting for Bleeding in Non-Small Cell Lung Cancer

Yamashita, Shinichi; Tokuishi, Keita; Moroga, Toshihiko; Abe, Sosei; Yamamoto, Kozo; Miyahara, So; Yoshida, Yasuhiro; Yanagisawa, Jun; Hamatake, Daisuke; Hiratsuka, Masafumi; Yoshinaga, Yasuteru; Yamamoto, Satoshi; Shiraishi, Takeshi; Kawahara, Katsunobu; Iwasakai, Akinori

doi:10.1016/j.athoracsur.2012.11.005

Cited by 41 publications

(68 citation statements)

References 20 publications

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“…Although many previous studies have demonstrated that thoracoscopic lobectomy or segmentectomy is safe and feasible, few have addressed troubleshooting for vessel injury in detail and compared perioperative results in cases with and without vessel injury. 9,10,14,16 Our results show that patients without vessel injury had less intraoperative blood loss, a shorter operative time, and a shorter duration of chest tube drainage, which might indicate that thoracoscopic anatomic pulmonary resection carries a greater risk of vessel injury. However, mean blood loss in the vessel injury group was 269 AE 362 mL, necessitating no perioperative transfusion and causing no comorbidities due to operative blood loss.…”

Section: Discussionmentioning

confidence: 68%

“…Several studies have demonstrated the efficacy of TachoSil to control bleeding in general thoracic surgery, and it is considered useful to avoid postoperative air leakage in this field. 16,18 Because the pulmonary arteries are low-pressure vessels and the pulmonary arterial wall is very fragile, primary suturing via a thoracoscopic approach may cause tearing of the vessel, leading to catastrophic bleeding. Therefore, attaching sealants is considered to be reasonable, without sutures or clipping.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have reported intraoperative complications associated with a thoracoscopic approach, with particular emphasis on the management of vessel bleeding and the rate of conversion to thoracotomy. [9][10][11][12][13][14][15][16] Flores and colleagues 9 considered that these complications occurred in the early, middle, and later parts of the learning curve. Furthermore, Fournel and colleagues 10 demonstrated that the surgeon's experience was not associated with fewer intraoperative adverse events, and speculated that this lack of an apparent correlation might indicate that vascular hazards are inherent to a thoracoscopic approach.…”

Section: Introductionmentioning

confidence: 99%

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Troubleshooting for bleeding in thoracoscopic anatomic pulmonary resection

Igai

Kamiyoshihara

Igarashi

et al. 2016

Asian Cardiovasc Thorac Ann

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Introduction: The objective of this study was to evaluate intraoperative vessel injury and assess troubleshooting during thoracoscopic anatomic pulmonary resection. Methods: Between April 2012 and March 2016, 240 patients underwent thoracoscopic anatomic lung resection, 26 of whom were identified as having massive bleeding intraoperatively. We analyzed the injured vessel and the hemostatic procedure employed, then compared the perioperative outcomes in patients with (n ¼ 26) and without (n ¼ 214) vessel injury. In addition, we compared perioperative results based on the period when surgery was performed: early period: April 2012 to March 2014 (n ¼ 93) or late period: April 2014 to March 2016 (n ¼ 146). Results: The surgical procedures included 20 lobectomies and 6 segmentectomies. One of the 26 patients had vessel injury at 2 points, giving a total of 27 points of injury. Hemostasis was mostly achieved by application of thrombostatic sealant (63.0%). There were no significant differences in the length postoperative hospitalization (p ¼ 0.67) or morbidity rate (p ¼ 0.43) between the vessel injury and the no-vessel injury groups. There were no significant differences in the incidence of significant intraoperative bleeding (p ¼ 0.13) and total blood loss (p ¼ 0.13) between the early and late periods. Conclusions: Application of thrombostatic sealant is one of the useful methods to achieve hemostasis during thoracoscopic anatomic pulmonary resection. Vascular hazards are inherent to a thoracoscopic approach. Therefore, thoracic surgeons should always be concerned about significant intraoperative bleeding and treat it appropriately.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Troubleshooting for bleeding in thoracoscopic anatomic pulmonary resection

Igai

Kamiyoshihara

Igarashi

et al. 2016

Asian Cardiovasc Thorac Ann

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“…Methods of tamponade may include sponges on a clamp or "stick", use of the lung tissue to compress injuries, suction compression, and closure of staplers on the bleeding source (15,20,23,34,37,38). Use of electrocautery, clips, and other hemostatic agents may also be useful.…”

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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“…Hanna, et al 30) classifi ed the causes of conversion into four types: intraoperative complications, technical problems, anatomical problems, and oncological conditions, and it is important to recognize these, make efforts to avoid conversion, 31) learn troubleshooting, and prepare for an emergency. 32,33) The merits of thoracoscopic surgery have been clarifi ed, and the usefulness of its active application for the elderly has been described. 34) For further development, it is necessary to consider education, 35) improvement of surgical operability, and the cost-benefi t.…”

Section: Thoracoscopic Lobectomy For Primary Lung Cancermentioning

confidence: 99%

Systematic Review of Published Studies on Safety and Efficacy of Thoracoscopic and Robot-Assisted Lobectomy for Lung Cancer

Nakamura

2014

ATCS

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The safety and effi cacy of thoracoscopic and robot-assisted lobectomies for primary lung cancer were reviewed in the literature. Thoracoscopic surgery is less invasive compared to thoracotomy, and it has been reported to be superior with regard to the outcome. In addition, the operability of a surgical robot (da Vinci) is favorable and supplements the disadvantages of conventional endoscopic surgery. Robot-assisted lobectomy has been reported to be comparable to thoracoscopic surgery with regard to the safety and effi cacy based on analysis of perioperative results and superior with regard to the operability and length of the learning curve. However, a high cost and a long operative time are of concern. Since robot-assisted surgery has been performed only in early cases, the continuation of a comparative investigation may be necessary.

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Totally Thoracoscopic Surgery and Troubleshooting for Bleeding in Non-Small Cell Lung Cancer

Cited by 41 publications

References 20 publications

Troubleshooting for bleeding in thoracoscopic anatomic pulmonary resection

Troubleshooting for bleeding in thoracoscopic anatomic pulmonary resection

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

Systematic Review of Published Studies on Safety and Efficacy of Thoracoscopic and Robot-Assisted Lobectomy for Lung Cancer

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