73 - Videositzung
16. Mai 2019, 17:30 - 19:00, Bellavista 2, 6. OG
Management of bleeding during minimally invasive lung resections: Tips and tricks for a stepwise approach (video)
J. A. Lutz, R. A. Schmid, G. J. Kocher, Presenter: J. A. Lutz (Bern)
Anatomical lung resections are procedures during which dissection of high flow vessels is required and subsequently haemorrhage is the most feared intraoperative complication. In the context of a teaching hospital with approximately 70% of anatomical resections done by a minimally invasive approach, specific skills in bleeding control are therefore imperative.
During the years 2017 and 2018 we performed a total of 340 anatomical lung resections at our institution, whereby 230 (68%) were done by uniportal VATS. Since the majority of procedures are routinely recorded for teaching purposes, we reviewed cases with major intraoperative bleeding in order to present our stepwise approach for bleeding management.
During the two year study period 6 patients had major intraoperative bleeding events (2.6%). Successful bleeding control was achieved by VATS in 4 of them, while conversion to thoracotomy was necessary in 2 patients. Excerpts from the intraoperative videos were compiled, demonstrating the different techniques of bleeding control.
The first important step to approach intraoperative bleeding is temporary bleeding control by simple compression, using a peanut, a sponge or for example lung tissue. Then, the extent of the lesion can be evaluated and a subsequent management strategy can be developed. While most vascular injuries can be controlled by means of thoracoscopy with compression and application of hemostatic material or clips, suturing of larger lacerations is generally more challenging in VATS and therefore - depending on the surgeons experience - ‘early’ conversion to open thoracotomy may be considered in such cases.