Control Of Bleeding During Thoracoscopic Surgery Using Human Fibrinogen/Thrombin-Coated Collagen Patch
Jun Suzuki, Hiroyuki Oizumi, Hirohisa Kato, Akira Hamada, Hikaru Watarai, Kenta Nakahashi, Takayuki Sasage, Mitsuaki Sadahiro.
Yamagata University Faculty of Medicine Second Department of Surgery, Yamagata, Japan.
Background When unexpected intraoperative bleeding occurs during thoracoscopic surgery, whether emergency conversion to thoracotomy is performed must be determined. Recently, the application of fibrinogen/thrombin-coated collagen patches has been used to manage the bleeding. The purpose of this study is to review our experience of encountering unexpected bleeding during thoracoscopic surgery, and to show the techniques to control intraoperative bleeding. Methods Between January 2004 and December 2017, 621 patients underwent thoracoscopic anatomic lung resection, and in 57 (9.1%) cases, unexpected bleeding occurred. These patients were identified as having intraoperative vessel injury. The results of these procedures were reviewed. How to control thoracoscopic surgery intraoperative bleeding When unexpected breeding occurred, the bleeding point was compressed at the lung parenchyma for at least 5 minutes. If the bleeding could not be controlled, a piece of the patch (cut 1 cm × 1 cm) that was adhered on the surface of the bleeding point was applied. It was pressed for a few minutes using cotton swabs for thoracoscopic surgery. After confirming hemostasis, ligation or clipping and suturing was not performed to reinforce the injured vessels. If two or three attempts with the patch were unsuccessful, VATS was converted to thoracotomy. Results Thirteen (2%) of these cases required open conversion, and 44 had controlled bleeding intraoperatively. In the thoracoscopic controlled bleeding cases, the main injured vessels were the pulmonary artery (n = 30), pulmonary vein (n = 12) and others (n=2 azygos vein, lung parenchyma). In the conversion to thoracotomy cases, the pulmonary artery was injured in all cases (n=13). This method was used in 44 all thoracoscopic cases, and primary closure was performed in all open conversion cases. The main causes of injury were related to technical issues. There was no morbidity and mortality related to intraoperative bleeding. The operation times (208 vs 227 minutes, avarage P=0.31) were not significantly different, but blood loss (160 vs 318 mL, average, P=0.008) was significantly greater in the conversion to thoracotomy cases. Perioperative morbidities and duration of chest tube insertion (1.89 vs. 1.85 days, average, p = 0.17) were not significantly different. However, the postoperative hospital stay (6.3 vs. 11 days, average, p = 0.86) was longer in the conversion to thoracotomy cases. Conclusion Controlling bleeding by using the application of a fibrinogen/thrombin-coated collagen patch is an effective procedure to manage vascular injury during thoracoscopic anatomic lung resection.
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