title: Complications after ultrasonic lung parenchyma biopsy: a strong note for caution.
abstract: BACKGROUND
  This study aimed to determine the possible cause for an unacceptable frequency of postresectional pneumothorax in cases of ultrasonic scalpel use without a further reinforcing maneuver in lung biopsy during video-assisted thoracic surgery (VATS).
  
  
  METHODS
  Data for a series of 16 consecutive VATS lung biopsy patients (group A) in which a disturbingly high number of minor and medium complications occurred were compared with data for a group of 20 patients previously subject to the same ultrasonic lung biopsy method (group B) without complication.
  
  
  RESULTS
  The two groups were identical in terms of all significant factors considered in relation to ultrasonic scalpel biopsy. Six notable air leakage complications occurred among the 16 patients of group A. One patient needed redrainage while still in the hospital. Two other patients required readmission and redrainage. In 4 of the 16 cases, late pneumothorax was detected after a "silent" 48-h postoperative period prolonging their hospital stay. Altogether, three medium complications occurred in group A, as compared with none in group B. The drainage duration in group B was not significantly shorter than in group A . Multivariate analysis showed a significant difference in complications favoring group B (odds ratio, 1.88).
  
  
  CONCLUSIONS
  A high postoperative air leakage rate was observed in a simple case series using an unsecured harmonic scalpel after a randomized trial of the same method in the same institute with a diametrically opposite outcome. The medium complication rate of 3 in 16 cases is unacceptable for a minor procedure such as lung biopsy. The two groups differed only in their thromboembolic prophylaxis protocol. Therefore, it is hypothesized that the recent introduction of low-molecular-weight heparin from day 1 may influence the complication rate. The authors' observation calls for caution in use of the harmonic scalpel on lung tissue without reinforcing maneuvers (i.e., stitches or clips). To avoid unnecessary complications, operative technique adjustment is recommended.
authors.affiliation: Department of Surgery, Medical School, University of Pécs, H-7633, Pécs, Ifjuság u. 13, Hungary. mft@iseb.pote.hu
authors.forename: T F
authors.initials: TF
authors.lastname: Molnar
authors.forename: I
authors.initials: I
authors.lastname: Benko
authors.forename: Z
authors.initials: Z
authors.lastname: Szanto
authors.forename: A
authors.initials: A
authors.lastname: Nagy
authors.forename: O P
authors.initials: OP
authors.lastname: Horvath
mesh_terms: D000328:Adult; D017677:Age Distribution; D001707:Biopsy, Needle / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D016001:Confidence Intervals; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006491:Hemothorax / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013525:Surgical Instruments / Q000009:adverse effects; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D014465:Ultrasonics / Q000009:adverse effects