The first video-assisted thoracic surgery (VATS) anatomic lobectomy for lung cancer was described two decades ago. During this time VATS has become a safe and effective approach for the treatment of lung cancer with a low level of morbidity and mortality.
Nowadays, thanks to advances in VATS and the experience gained, most pulmonary resections can be performed by video-assisted thoracoscopy in a safe way.
By gaining experience, more complex or advanced cases are approached using the VATS technique. However, as VATS lobectomy is applied to more advanced cases, the conversion rate to open thoracotomy can increase, especially during the learning curve, mostly because of the occurrence of intraoperative complications.
The best plan to solve complications during VATS lobectomy is to avoid them. Perform a pulmonary resection as safe as possible by VATS depends on the patient selection, the patient’s characteristics and the anticipated technical aspects of the case as well as a careful pulmonary dissection. Regardless of all the prevention of intraoperative complications, these can occur, so we must develop plans or strategies to minimize them if they occur.
The correct assessment of any bleeding is paramount during thoracoscopic major procedures. Major vessel injury may cause massive bleeding in case of an inadequate management of the defect. If bleeding occurs, a sponge stick should be available to apply pressure immediately to control the haemorrhage. Then a decision must be made promptly as to whether thoracotomy is needed or if it can be solved through the VATS approach. This will depend mostly on the surgeon’s experience.
What should be clear is that an intraoperative complication should not become an intraoperative catastrophe.
This is a preview of subscription content, log in to check access.
Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trial son safety and efficacy of video assisted thoracic surgery lobectomy for early-stage non-small-cell lung cáncer. J Clin Oncol. 2009;27:2553–62.CrossRefGoogle Scholar
Mc Kenna RJ Jr, Houck W, Fuller CB. Video assisted thoracic surgery lobectomy: experience with 1,100 cases. Ann Thorac Surg. 2006;81:421–6.CrossRefGoogle Scholar
Daniels LJ, Balderson SS, Onaitis MW, et al. Thoracoscopic lobectomy: a safe and effective strategy for patients with stage I lung cancer. Ann Thorac Surg. 2002;74(3):860–4.CrossRefGoogle Scholar
Berry F, D’Amico T. Complications of thoracoscopic pulmonary resection. Semin Thorac Cardiovasc Surg. 2007;19:350–4.CrossRefGoogle Scholar
Swada S, Komori E, Yamashita M. Evaluation of video-assisted thoracoscopic surgery requiring emergency conversion to thoracotomy. Eur J Cardiothorac Surg. 2009;36(3):487–90.CrossRefGoogle Scholar
Hanna J, Berry M, D’Amico T. Contraindications of video-assisted thoracoscopic surgical lobectomy and determinants of conversion to open. J Thorac Dis. 2013;5(Suppl 3):S182–9.PubMedPubMedCentralGoogle Scholar
Flores RM, Ihekweazu U, Dycoco J, et al. Video-assisted thoracoscopic surgery (VATS) lobectomy: catastrophic intraoperative complications. J Thorac Cardiovasc Surg. 2011;142:142–7.CrossRefGoogle Scholar
Gonzalez-Rivas D, Stupnik T, Fernandez R. Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgery. Eur J Cardiothorac Surg. 2016;49(Suppl 1):i17–24.PubMedGoogle Scholar
Imperatori A, Rotolo N, Gatti M, et al. Peri-operative complications of video-assisted thoracoscopic surgery (VATS). Int J Surg. 2008;6(Suppl 1):S78–81.CrossRefGoogle Scholar
Cormier B, Nezhat F, Sternchos J, Sonoda Y, Leitao MM Jr. Electrocautery-associated vascular injury during robotic-assisted surgery. Obstet Gynecol. 2012;120:491–3.CrossRefGoogle Scholar
Demmy TL, James TA, Swanson SJ, McKenna RJ Jr, D’Amico TA. Troubleshooting video-assisted thoracic surgery lobectomy. Ann Thorac Surg. 2005;79:1744–52.CrossRefGoogle Scholar
Fernandez Prado R, Fieira Costa E, Delgado Roel M, Fernandez LM, de la Morena P, de la Torre M, Gonzalez-Rivas D. Management of complications by uniportal video-assisted thoracoscopic surgery. J Thorac Dis. 2014;6(S6):S669–73.PubMedPubMedCentralGoogle Scholar
Mei J, Pu Q, Liao H, et al. A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy. Surg Endosc. 2013;27:530–7.CrossRefGoogle Scholar
Nakanishi R, Oka S, Odate S. Video-assisted thoracic surgery major pulmonary resection requiring control of the main pulmonary artery. Interact Cardiovasc Thorac Surg. 2009;9:618–22.CrossRefGoogle Scholar
Kamiyoshihara M, Nagashima T, Ibe T, Takeyoshi I. A tip for controlling the main pulmonary artery during video-assisted thoracic major pulmonary resection: the outside-field vascular clamping technique. Interact Cardiovasc Thorac Surg. 2010;11:693–5.CrossRefGoogle Scholar