Algorithm-based troubleshooting to manage bleeding during thoracoscopic anatomic pulmonary resection.
Algorithm
intraoperative bleeding
pulmonary resection
thoracoscopy
troubleshooting
Journal
Journal of thoracic disease
ISSN: 2072-1439
Titre abrégé: J Thorac Dis
Pays: China
ID NLM: 101533916
Informations de publication
Date de publication:
Nov 2019
Nov 2019
Historique:
entrez:
7
1
2020
pubmed:
7
1
2020
medline:
7
1
2020
Statut:
ppublish
Résumé
Few studies have reported on the effects of intraoperative complications, such as vessel injury, during thoracoscopic anatomic pulmonary resection. We evaluated intraoperative vessel injury and assessed troubleshooting methods for thoracoscopic anatomic pulmonary resection. A total of 378 patients underwent thoracoscopic anatomic pulmonary resection between April 2012 and March 2018, 40 of whom were identified as having an intraoperative vessel injury. In our department, we treat significant bleeding based on the algorithm shown in Figure 1. We analyzed the injured vessels and hemostatic procedures employed and compared perioperative outcomes in patients with (n=40) or without (n=338) a vessel injury. Additionally, we examined the data on a year-by-year basis from April 2012, and perioperative results were compared in each year. The vessel injured was a branch of the pulmonary artery in 22 cases (55%). Hemostasis was achieved by applying a thrombostatic sealant in 26 cases (65%). Although patients without a vessel injury had a shorter operation time, less intraoperative blood loss, and shorter duration of chest tube drainage, no significant differences in the length of postoperative hospitalization or morbidity were observed. The occurrence rate of significant intraoperative bleeding in the last year measured was similar to that in the first year measured. Thoracoscopic anatomic pulmonary resection is feasible and safe if the surgeon performs appropriate hemostasis, although vascular hazards might be inherent during thoracoscopic anatomic pulmonary resection, regardless of the surgeon's experience.
Sections du résumé
BACKGROUND
BACKGROUND
Few studies have reported on the effects of intraoperative complications, such as vessel injury, during thoracoscopic anatomic pulmonary resection. We evaluated intraoperative vessel injury and assessed troubleshooting methods for thoracoscopic anatomic pulmonary resection.
METHODS
METHODS
A total of 378 patients underwent thoracoscopic anatomic pulmonary resection between April 2012 and March 2018, 40 of whom were identified as having an intraoperative vessel injury. In our department, we treat significant bleeding based on the algorithm shown in Figure 1. We analyzed the injured vessels and hemostatic procedures employed and compared perioperative outcomes in patients with (n=40) or without (n=338) a vessel injury. Additionally, we examined the data on a year-by-year basis from April 2012, and perioperative results were compared in each year.
RESULTS
RESULTS
The vessel injured was a branch of the pulmonary artery in 22 cases (55%). Hemostasis was achieved by applying a thrombostatic sealant in 26 cases (65%). Although patients without a vessel injury had a shorter operation time, less intraoperative blood loss, and shorter duration of chest tube drainage, no significant differences in the length of postoperative hospitalization or morbidity were observed. The occurrence rate of significant intraoperative bleeding in the last year measured was similar to that in the first year measured.
CONCLUSIONS
CONCLUSIONS
Thoracoscopic anatomic pulmonary resection is feasible and safe if the surgeon performs appropriate hemostasis, although vascular hazards might be inherent during thoracoscopic anatomic pulmonary resection, regardless of the surgeon's experience.
Identifiants
pubmed: 31903243
doi: 10.21037/jtd.2019.10.72
pii: jtd-11-11-4544
pmc: PMC6940248
doi:
Types de publication
Journal Article
Langues
eng
Pagination
4544-4550Commentaires et corrections
Type : CommentIn
Informations de copyright
2019 Journal of Thoracic Disease. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: Meeting presentation: the abstract was presented at the Clinical/Outcomes, Cardiothoracic and Vascular QuickShot Session, American Surgical Congress, Houston, TX, USA, on 7 February 2019.
Références
Eur J Cardiothorac Surg. 2009 Sep;36(3):487-90
pubmed: 19502073
Eur J Cardiothorac Surg. 2013 Apr;43(4):813-7
pubmed: 22826474
Eur J Cardiothorac Surg. 2014 Apr;45(4):640-5
pubmed: 24052605
Surg Endosc. 2013 Feb;27(2):530-7
pubmed: 22806532
J Thorac Cardiovasc Surg. 2010 Apr;139(4):976-81; discussion 981-3
pubmed: 20172539
Asian J Endosc Surg. 2014 Nov;7(4):342-4
pubmed: 25354384
Asian Cardiovasc Thorac Ann. 2017 Jan;25(1):35-40
pubmed: 27920230
Eur J Cardiothorac Surg. 2014 Oct;46(4):607-13
pubmed: 24603446
Surg Endosc. 2008 Feb;22(2):298-310
pubmed: 17943372
J Thorac Dis. 2013 Aug;5(4):513-7
pubmed: 23991310
Ann Thorac Surg. 2013 Mar;95(3):994-9
pubmed: 23295043
Surg Today. 2016 Aug;46(8):901-7
pubmed: 26411432
Ann Thorac Surg. 2014 Feb;97(2):419-24
pubmed: 24266953
J Thorac Cardiovasc Surg. 2011 Dec;142(6):1412-7
pubmed: 22014713