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A Proposal For The Classification Of Troubleshooting In Video-assisted Thoracic Surgery: How To Cope With Unanticipated Problems
Mitsuhiro Kamiyoshihara;
Maebashi Red Cross Hospital, Maebashi, Japan
BACKGROUND: 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. We used direct visualization or monitoring as the situation demanded, switching back and forth between the monitor and direct vision.
RESULTS: Thirty-six patients had malignant lung disease and ten had benign lung disease. All 46 patients underwent lobectomies including one or more of the following: bronchoplasty (n = 15), control of the main pulmonary artery (n = 12), total adhesiotomy (n = 11), combined resection with the diaphragm (n = 5), and separation of totally fused fissures (n = 3). The mean total operating time was 198 min, and the mean blood loss was 166 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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