title: Totally thoracoscopic surgery and troubleshooting for bleeding in non-small cell lung cancer.
abstract: BACKGROUND
  Although accumulating data support the feasibility and efficacy of video-assisted thoracic surgery anatomic resection, few studies have reported on intraoperative complications, such as vessel injury. The purpose of this study was to evaluate intraoperative vessel injury and to analyze troubleshooting.
  
  
  METHODS
  Twenty-six of 557 patients with non-small cell lung cancer who underwent thoracoscopic anatomic lung resection were identified as having intraoperative vessel injury between January 2004 and December 2011. The injured portion, devices used, recovery approach, and hemostatic procedure were analyzed. The perioperative outcomes in patients with and without vessel injury were compared.
  
  
  RESULTS
  The most commonly used devices were ultrasonic coagulation shears in 9 cases, followed by scissors in 5 and an endostapler in 4. Seventeen of the 26 cases were injured at the branches of the pulmonary artery, and the others were at major vessels. Half of the patients were converted to thoracotomy, and 6 were treated by minithoracotomy. Hemostatic procedures were primary closure in 17 and sealant in 7. The perioperative outcomes, including operative time and blood loss, were significantly different between the two groups, but duration of chest tube drainage, length of hospital stay, and morbidity rate were not. No mortality was identified in the patients with vessel injury.
  
  
  CONCLUSIONS
  Video-assisted thoracic surgery anatomic resection was feasible and safe, regardless of the intraoperative vessel injury. Although surgeons should pay attention to avoid unexpected bleeding, the magnitude of injury and effectual step-by-step management should lead to a safe operation.
authors.affiliation: Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University School of Medicine, Fukuoka, Japan. yamashi1@fukuoka-u.ac.jp
authors.forename: Shin-Ichi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Keita
authors.initials: K
authors.lastname: Tokuishi
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Moroga
authors.forename: Sosei
authors.initials: S
authors.lastname: Abe
authors.forename: Kozo
authors.initials: K
authors.lastname: Yamamoto
authors.forename: So
authors.initials: S
authors.lastname: Miyahara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Jun
authors.initials: J
authors.lastname: Yanagisawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hamatake
authors.forename: Masafumi
authors.initials: M
authors.lastname: Hiratsuka
authors.forename: Yasuteru
authors.initials: Y
authors.lastname: Yoshinaga
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shiraishi
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Kawahara
authors.forename: Akinori
authors.initials: A
authors.lastname: Iwasakai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*