title: [Intraoperative bleeding during thoracic surgery : avoidance strategies and surgical treatment concepts].
abstract: BACKGROUND
  As a direct result of the thoracic anatomy, heavy bleeding is possible during nearly all central resections in thoracic surgery.
  
  
  OBJECTIVE
  Description of the incidence of intraoperative bleeding including avoidance strategies and treatment concepts. Presentation of special anatomical features of pulmonary arteries.
  
  
  METHODS
  A literature search was performed in Pubmed, medline and by manual searching. Publications from the last 60 years were analyzed and the results are summarized in a structured review.
  
  
  RESULTS
  Little data is available on the incidence of intraoperative bleeding during thoracic surgery. Most data were collected retrospectively. For mediastinoscopy the incidence of severe bleeding is 0.2 %, for minimally invasive anatomical resections the incidence of intraoperative bleeding is 4.7 % and for open surgery 5 %. Bleeding from the central pulmonary artery can take a dramatic course and requires rapid and targeted therapy.
  
  
  CONCLUSIONS
  Knowledge of the anatomical topographic details, the structure, the course and the specific features of the vessels of the lungs is essential to prevent and treat bleeding. Avoidance strategies include techniques of proximal and distal vessel control, intrapericardial preparation and sharp preparation in general. Techniques of forward-looking preparation and well-prepared exit strategies in case of bleeding have to be part of the training in thoracic surgery.
authors.affiliation: Klinik für Thoraxchirurgie, Dr. Horst Schmidt Klinik GmbH, Klinikum der Landeshauptstadt Wiesbaden und der Helios Kliniken Gruppe, Ludwig-Erhard-Str. 100, 65199, Wiesbaden, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Schirren
authors.forename: S
authors.initials: S
authors.lastname: Sponholz
authors.forename: S
authors.initials: S
authors.lastname: Oguhzan
authors.forename: N
authors.initials: N
authors.lastname: Kudelin
authors.forename: C
authors.initials: C
authors.lastname: Ruf
authors.forename: S
authors.initials: S
authors.lastname: Trainer
authors.forename: J
authors.initials: J
authors.lastname: Schirren
mesh_terms: D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000379:methods; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery*; D008481:Mediastinoscopy / Q000009:adverse effects; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*