title: Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience.
abstract: OBJECTIVE
  Unexpected intraoperative bleeding during thoracoscopic surgery, necessitating emergency conversion to thoracotomy, is gradually being reported. We reviewed our experience of encountering unexpected bleeding during thoracoscopic surgery.
  
  
  METHODS
  We defined "unexpected intraoperative bleeding" as the need for hemostatic procedures with angiorrhaphy, with or without a sealant. The location, cause, and management of injured vessels, and perioperative outcomes were investigated and compared with those for patients without injured vessels.
  
  
  RESULTS
  Between 2007 and 2014, a total of 241 thoracoscopic anatomical pulmonary resections were performed at our hospital. Twenty (8.3 %) of these patients required hemostatic procedures with angiorrhaphy, with or without a sealant. The main injured vessels were the pulmonary artery (n = 13) and vein (n = 3) and the main causes of injury were related to technical issues with energy devices and staplers. There were no morbidities related to intraoperative bleeding. The operation time and blood loss were significantly greater in the patients with vessel injury than in those without vessel injury, but perioperative morbidities and the duration of chest tube insertion (4.5 vs. 3.5 days, average, p = 0.20) and postoperative hospital stay (12.7 vs. 11.0 days, average, p = 0.08) were not significantly different.
  
  
  CONCLUSIONS
  The frequency of unexpected bleeding was relatively high in this series, but its management and outcomes were satisfactory in terms of safety.
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. miyataku@nagasaki-u.ac.jp.
authors.forename: Takuro
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamasaki
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Tomoshi
authors.initials: T
authors.lastname: Tsuchiya
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Hatachi
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kitamura
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Obata
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Ryoichiro
authors.initials: R
authors.lastname: Doi
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Machino
authors.affiliation: Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000601:surgery; D005260:Female; D015718:Fibrin Tissue Adhesive; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000628:therapy*; D007902:Length of Stay; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D011013:Pneumonectomy / Q000379:methods*; D011651:Pulmonary Artery / Q000293:injuries; D011667:Pulmonary Veins / Q000293:injuries; D013528:Surgical Staplers / Q000009:adverse effects; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Bleeding; Non-small cell lung cancer; Thoracoscopic surgery