Management of complications in thoracoscopic surgery.

Background: Thoracoscopic surgery has been widely performed. However, sometimes open conversion becomes necessary to manage complications. We have been applying thoracoscopic technique to manage complications to minimize the rate of open conversion.

Methods: Thoracoscopic suture technique in addition to some other technique has been used to control intraoperative bleeding, nerve injury and bronchial damage. Pulmonary artery bleeding could happen in thoracoscopic surgery. First step is to give compression to the bleeding point. Usually the lung nearby is used then a gauze is taken over. A piece of Tachosil® is placed to stop bleeding. When this technique is not successful, the proximal part of the PA is encircled with a vascular sling to reduce the blood flow. In some occasion, bleeding point is suture closed. This technique is also used in controlling the bleeding from the right atrium. Phrenic nerve could be severed incidentally or on purpose to remove malignancy. Direct suture or intercostal nerve interposition may fix the problem. Trachea or bronchus could be damaged incidentally. Thoracoscopic suture closure will be helpful. Between 2013 and 2017, we performed 2,527 thoracoscopic surgical procedures including 1,196 major lung resections were performed in our department.

Results: There was no procedure related mortality. In our institution, open conversion to manage complications was 0.3% in consecutive 6,929 thoracoscopic surgery and 0.63% in thoracoscopic major lung resection since 2000. In 2014 to 2017 open conversion could be reduced to 0.4% of the major lung resections. Most of the complications in thoracoscopic surgery were managed with thoracoscopic methods.

Conclusions: Applying thoracoscopic suture technique and other options could reduce the rate of open conversion in thoracoscopic surgery.