Intra-operative bleeding during VATS lung surgery

1. Intra-operative bleeding during VATS lung surgery AATS Focus on Lung CancerBostonNov 2012 Scott J. Swanson, M.D. Director, Minimally Invasive Thoracic Surgery Brigham and Women’s Hospital Professor of Surgery Harvard Medical School

2. Disclosures • I have no conflicts for this talk • I serve as a consultant to Covidien and Ethicon

3. Biggest hindrance to adoption of VATS lobectomy Fear of dangerous bleeding

4. Significant Serious Bleeding during VATS lung surgery Rare event 17/414 (4.11%) – encountered bleeding during VATS anatomic pulmonary resection over 5 year period 15/17 (88%) – managed without conversion 2/17 (12%) – required thoracotomy due to difficulty clamping proximal left PA Bleeding – 60-935, median 350 ml Total conversion – 11/414 (2.7%) – hilar nodes most common reason A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomy Mei, Pu, Liao, Ma, Zhu and Liu. Surg Endosc. 2012

5. A novel method for troubleshooting vascular injury during anatomic thoracoscopic pulmonary resection without conversion to thoracotomyMei, Pu, Liao, Ma, Zhu and Liu. SurgEndosc. 2012

6. Bleeding during VATS middle lobectomy

7. VATS completion left pneumonectomy 84 yo lawyer with 4 lung cancers 1st – LLL adeno/bac treated with wedge resection 9 years ago Recurrence in left lower lobe 4 years later treated with VATS left lower lobectomy New lung cancer in right upper lobe treated with wedge resection 3 years ago 3 months ago new left hilar lung cancer Treated with completion pneumonectomy

8. Left hilar cancer following left lower lobectomy and xrt

9. Bleeding during VATS pneumonectomy requiring conversion

10. Summary Bleeding during VATS anatomic resection is uncommon but is encountered Control is relatively straightforward Conversion is controlled and safe Fear of bleeding should not be a hindrance to VATS lung surgery