Morbidity in Video-Assisted Thoracoscopic Lobectomy for Clinical Stage I Non-Small Cell Lung Cancer: Is VATS Lobectomy Really Safe?

Abstract

Pulmonary vessel injury, longer operation times, and greater blood loss have been frequently observed with VATS lobectomy. Proficiency is required to perform VATS lobectomy, and the procedure should be performed by a well-trained surgeon as indicated by the results of this study.

Pulmonary Artery Bleeding During Video-Assisted Thoracoscopic Surgery

“…Retraction to expose the pulmonary artery can lead to excessive tension that puts the structure at risk for tearing with even gentle manipulation. 28 Bleeding in this situation can occur quite suddenly, and surgeons must always bear this in mind and be ready to control bleeding that appears. A second cause of bleeding can be an injury to, from the surgeons' viewpoint, the posterior aspect of the pulmonary artery (see Fig.…”

“…Several series have shown that the need for conversion to thoracotomy during VATS lobectomy decreases with time and experience, suggesting that surgeons gain confidence and skills to deal with difficult or unexpected situations as their overall experience increases. 23,28,33 Although pulmonary artery bleeding can be controlled and repaired by thoracoscopic techniques, it should be noted that most (92%) of a panel of 50 international experts across 16 countries on VATS lobectomy recommend conversion to open thoracotomy when major bleeding is encountered. 21 When considering attempts to control pulmonary artery bleeding thoracoscopically, surgeons should evaluate their own experience, as this same panel of experts agreed that a surgeon must have performed at least 50 cases overall and at least 20 annually to consider themselves technically proficient.…”

Massive Intraoperative Blood Loss Secondary to Pulmonary Artery Injury During a Video-Assisted Thorascopic Surgery: The Importance of Protocols and Preparedness

“…While there are benefits to this less invasive technique, it requires a great level of skill. Kawachi, et al concluded that pulmonary vessel injury, longer operation times, and greater blood loss have frequently been observed with VATS lobectomies [2]. Massive bleeding from vascular injury is, according to Mei, et al, “considered the most troublesome and dangerous complication during VATS pulmonary resection and is an important reason for emergency conversion to thoracotomy” [3].…”

Systematic Review of Published Studies on Safety and Efficacy of Thoracoscopic and Robot-Assisted Lobectomy for Lung Cancer

“…Although only a few reports from Japan were included, recent results after 2005 are shown in Table 2. [20][21][22][23][24][25] Similarly, the blood loss, duration of drainage period, length of hospital stay, and complication rates of VATS were favorable, although the operative time was long. In addition, the postoperative pain level and QOL were also favorable, and favorable outcomes, such as an early return to normal life and conservation of the respiratory function, were achieved.…”