title: Intraoperative bleeding control by uniportal video-assisted thoracoscopic surgery†.
abstract: Owing to advances in video-assisted thoracic surgery (VATS), the majority of pulmonary resections can currently be performed by VATS in a safe manner with a low level of morbidity and mortality. The majority of the complications that occur during VATS can be minimized with correct preoperative planning of the case as well as careful pulmonary dissection. Coordination of the whole surgical team is essential when confronting an emergency such as major bleeding. This is particularly important during the VATS learning curve, where the occurrence of intraoperative complications, particularly significant bleeding, usually ends in a conversion to open surgery. However, conversion should not be considered as a failure of the VATS approach, but as a resource to maintain the patient's safety. The correct assessment of any bleeding is of paramount importance during major thoracoscopic procedures. Inadequate management of the source of bleeding may result in major vessel injury and massive bleeding. If bleeding occurs, a sponge stick should be readily available to apply pressure immediately to control the haemorrhage. It is always important to remain calm and not to panic. With the bleeding temporarily controlled, a decision must be made promptly as to whether a thoracotomy is needed or if the bleeding can be solved through the VATS approach. This will depend primarily on the surgeon's experience. The operative vision provided with high-definition cameras, specially designed or adapted instruments and the new sealants are factors that facilitate the surgeon's control. After experience has been acquired with conventional or uniportal VATS, the rate of complications diminishes and the majority of bleeding events are controlled without the need for conversion to thoracotomy.
authors.affiliation: Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain diego.gonzalez.rivas@sergas.es.
authors.forename: Diego
authors.initials: D
authors.lastname: Gonzalez-Rivas
authors.affiliation: Department of Thoracic Surgery, University Medical Center, Ljubljana, Slovenia.
authors.forename: Tomaz
authors.initials: T
authors.lastname: Stupnik
authors.affiliation: Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fernandez
authors.affiliation: Department of Thoracic Surgery, Coruña University Hospital and Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: de la Torre
authors.affiliation: Department of Cardiovascular Surgery, Coruña University Hospital, Coruña, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Velasco
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Wentao
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
authors.forename: Gening
authors.initials: G
authors.lastname: Jiang
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control*; D061887:Conversion to Open Surgery; D016558:Hemostasis, Endoscopic / Q000295:instrumentation / Q000379:methods*; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D011013:Pneumonectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
keywords: Bleeding; Thoracoscopic complications; Uniportal VATS; Vascular control