Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience

Surg Endosc. 2019 Jun;33(6):1880-1889. doi: 10.1007/s00464-018-6467-7. Epub 2018 Sep 26.


Background: Our objective is to report on two centers' experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis.

Methods: Consecutive patients (n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury.

Results: There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate (p = 0.005, Odds ratio 4.415, 95% CI 1.424-13.685) and multivariate analysis (p = 0.006, Odds ratio 4.926, 95% CI 1.577-15.384). Operative time (p < 0.001), blood loss (p < 0.001), and post-operative hospital stay (p = 0.012) were longer in patients with major vascular injury. There were no differences in 30-day mortality and 90-day morbidity.

Conclusions: In summary, major intra-operative bleeding episodes during SPVATS anatomic lung resections are acceptable and most such bleeding episodes can be safely managed with SPVATS techniques.

Keywords: Bleeding episodes; Complications; Management; Risk factor analysis; Single-port VATS.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Blood Loss, Surgical / statistics & numerical data
  • Case-Control Studies
  • Cohort Studies
  • Female
  • Hemorrhage / surgery*
  • Humans
  • Intraoperative Complications / surgery*
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Operative Time
  • Pneumonectomy / methods*
  • Retrospective Studies
  • Risk Factors
  • Thoracic Surgery, Video-Assisted*