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Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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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Abbreviations

SPVATS:

Single-port video-assisted thoracoscopic surgery

PET:

Positron emission tomography

CT:

Computed tomography

MRI:

Magnetic resonance imaging

EBUS-FNA:

Endobronchial ultrasound biopsy fine needle aspiration

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Author information

Study conception and design: CFW, DG-R, TM, RF, CYW. Acquisition of data: CFW, TM, RF, MD, EF, CYW, MJH, MP, YHL, YKC, DG-R. Analysis and interpretation of data: CFW, MD, CYW. Drafting of manuscript: CFW, TM, RF, DG-R. Critical revision: CFW, TM, DG-R.

Correspondence to Diego Gonzalez-Rivas.

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Disclosures

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.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1: Unexpected superior segmental artery injury occurred during dissection of superior segmentectomy artery. Supplementary material 1 (MP4 270060 KB)

Video 1: Unexpected superior segmental artery injury occurred during dissection of superior segmentectomy artery. Supplementary material 1 (MP4 270060 KB)

Video 2: Repaired oozing staple line with suture. Supplementary material 2 (MP4 169788 KB)

Video 2: Repaired oozing staple line with suture. Supplementary material 2 (MP4 169788 KB)

Supplementary material 3 (DOCX 112 KB)

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Cite this article

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

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Keywords

  • Single-port VATS
  • Complications
  • Bleeding episodes
  • Risk factor analysis
  • Management