V-130 Intraoperative bleeding control during uniportal VATS lobectomy learning curve

Hintergrund

Intraoperative bleeding during uniportal VATS lobectomy is considered one of the main concerns and in hands of a less skilled surgeon or during learning curve usually ends in conversion to thoracotomy. One of the major issues regarding intraoperative bleeding control through a very limited single-incision approach is to choose the right strategy to control it. It is of utmost importance to initially control the bleeding site, to prevent a further damage to an injured vessel and to maintain the patient’s safety throughout the bleeding repair. Aim of our review was to evaluate whether intraoperative bleeding, including significant one, can be repaired in a safe manner by uniportal VATS during learning curve period.

 

MissingLinkText

Material und Methode

We reviewed a learing curve period of first 50 uniportal VATS lobectomies performed by a single surgeon. Our primary objective was to assess bleeding event rate, bleeding type, blood loss, type of intervention and conversion rate. Bleeding events that were controled by simple compression or with the use of sealants were excluded. Secondary goal was to evaluate need for transfusion, reoperation rate and length of hospital stay.

 

MissingLinkText

Ergebnis

All 50 uniportal VATS lobectomies were performed from October 2015 to March 2018. Bleeding event rate was 6 in 5 (10%) patients, 3 of them were major and 3 minor. Two bleeding events were repaired with use of vascular clip, 3 with suture and 1 with stapling device, respectively. Conversion to thoracotomy due to bleeding was needed in 1 patient out of 50 (2%). The average blood loss per bleeding patient was 450 ml. No blood transfusion and no reaoperation were needed. The average hospital stay was 2,8 days.

 

MissingLinkText

Schlussfolgerung

Only one patient needed conversion to thoracotomy to repair the bleeding, remaining 5 bleeding events (4 patients) were repaired by uniportal VATS and no reoperation was needed. Therefore we can conclude that majority of intraoperative bleedings, including major ones, can be repaired in safe manner by thoracoscopic approach during learning curve period. However, conversion to thoracotomy is mandatory before patient safety and life is put at risk.

 

MissingLinkText

 

MissingLinkText

Publication History

Article published online:
06 September 2021