Our objective is to report on two centers’ experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis.
Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury.
There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424–13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577–15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity.
In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.
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Single-port video-assisted thoracoscopic surgery
Positron emission tomography
Magnetic resonance imaging
Endobronchial ultrasound biopsy fine needle aspiration
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Ching Feng Wu, de la Torre Mercedes, Ricardo Fernandez, Maria Delgado, Eva Fieira, Ching Yang Wu, Ming Ju Hsieh, Marina Paradela, Yun Hen Liu, Yin Kai Chao, and Diego Gonzalez-Rivas have no conflicts of interest or financial ties to disclose.
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Wu, C.F., de la Mercedes, T., Fernandez, R. et al. Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience. Surg Endosc 33, 1880–1889 (2019). https://doi.org/10.1007/s00464-018-6467-7
- Single-port VATS
- Bleeding episodes
- Risk factor analysis