title: Brachial plexus injuries complicating video-assisted thoracic surgery.
abstract: OBJECTIVE
  Video-assisted thoracic surgery (VATS) is a less-invasive alternative to open thoracotomy. According to evidence-based medicine methodology, VATS is associated with better outcomes and the same complication rate as open thoracotomy.
  
  
  METHODS
  Two women (19 and 21 years old) underwent VATS for treatment of pneumothorax. In an attempt to perform hemostasis, the subclavian arteries had to be occluded. Total sensorimotor deficit in both patients on the side where surgery was performed was noticed postoperatively. After 3½ months in patient 1, nerve roots C5 and C6 were neurolyzed. Neuromas of middle and lower trunks and posterior and medial cords were resected and graft repair with sural nerves was performed. In the second patient, 1 month after VATS the entire plexus was neurolyzed because of severe fibrosis. Following neurolysis, positive nerve action potentials (NAPs) were recorded. Patient 1 after the 6-year follow-up has full range of motion of the shoulder and elbow. Extension and flexion in the wrist and fingers recovered to M4/5. Pain sensation and two-point discrimination recovered. Patient 2 after 2½-year follow-up recovered full range of motion of the shoulder, elbow, and forearm. Pain sensation recovered in dermatomes C5 and C6.
  
  
  CONCLUSIONS
  The two presented cases show that VATS is not without severe complications, as evidence-based medicine methodology suggests. Surgical findings in our patients imply that if this type of complication happens, early surgical exploration could be the best option for the patients.
authors.affiliation: Department of Neurosurgery, School of Medicine, University of Zagreb, Zagreb, Croatia. iskoro@gmail.com
authors.forename: Ivan
authors.initials: I
authors.lastname: Skoro
authors.forename: Kresimir
authors.initials: K
authors.lastname: Djuric
authors.forename: Marin F
authors.initials: MF
authors.lastname: Stancic
mesh_terms: D001917:Brachial Plexus / Q000293:injuries* / Q000503:physiopathology; D005260:Female; D005385:Fingers / Q000503:physiopathology; D006225:Hand / Q000503:physiopathology; D006470:Hemorrhage / Q000209:etiology; D006487:Hemostasis; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology / Q000628:therapy*; D009068:Movement; D010994:Pleura / Q000601:surgery; D011030:Pneumothorax / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy*; D020127:Recovery of Function; D012677:Sensation; D013348:Subclavian Artery / Q000503:physiopathology; D020775:Thoracic Surgery, Video-Assisted; D055815:Young Adult