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Unanticipated troubles in video-assisted thoracic surgery
Mitsuhiro Kamiyoshihara, Hitoshi Igai, Takashi Ibe, Natsuko Kawatani, Seshiru Nakazawa, Jun Atsumi, Yoichi Otak, Kai Obayashi, Toshiteru Nagahima, Seiichi Kakegawa, Masayuki Sugano, Osamu Kakegawa, Kimihiro Shimizu, Izumi Takeyoshi.
Maebashi Red Cross Hospital, Maebashi, Japan.

OBJECTIVE: Most thoracic surgeons encounter atypical cases or unexpected situations that usually lead them to convert minimally invasive surgery to open thoracotomy. Are there any other possibilities? We categorized video-assisted thoracic surgery (VATS) procedures for atypical cases or unexpected situations into two groups: the modification of techniques/instruments and the creation of additional access incisions. The purpose of this study was to suggest a VATS classification and present tips for the application of VATS to atypical cases or unexpected situations.
METHODS: We retrospectively reviewed VATS with optional additional techniques.
RESULTS: Twenty-seven patients had malignant lung disease and six had benign lung disease. All 33 patients underwent lobectomies including one or more of the following: bronchoplasty (n = 12), control of the main pulmonary artery (n = 9), total adhesiotomy (n = 7), combined resection with the diaphragm (n = 3), and separation of totally fused fissures (n = 2). The mean length of the skin incision was 8 cm, the mean total operating time was 208 min, and the mean blood loss was 173 g. No operative or hospital death occurred.
CONCLUSIONS: This idea may have educational benefits. Veteran surgeons can instinctively deal with intraoperative variance, but we frequently see inexperienced surgeons panic and stop their manipulations. Therefore, we believe that the creation of a categorized coping plan will help inexperienced surgeons cope with unanticipated problems.

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