@article{ATM33255,
author = {Lunxu Liu and Jiandong Mei and Jie He and Todd L. Demmy and Shugeng Gao and Shanqing Li and Jianxing He and Yang Liu and Yunchao Huang and Shidong Xu and Jian Hu and Liang Chen and Yuming Zhu and Qingquan Luo and Weimin Mao and Qunyou Tan and Chun Chen and Xiaofei Li and Zhu Zhang and Gening Jiang and Lin Xu and Lanjun Zhang and Jianhua Fu and Hui Li and Qun Wang and Deruo Liu and Lijie Tan and Qinghua Zhou and Xiangning Fu and Zhongmin Jiang and Haiquan Chen and Wentao Fang and Xun Zhang and Yin Li and Ti Tong and Zhentao Yu and Yongyu Liu and Xiuyi Zhi and Tiansheng Yan and Xingyi Zhang and Qiang Pu and Guowei Che and Yidan Lin and Lin Ma and Raul Embun and Javier Aragón and Serdar Evman and Gregor J. Kocher and Luca Bertolaccini and Alessandro Brunelli and Diego Gonzalez-Rivas and Joel Dunning and Hui-Ping Liu and Scott J. Swanson and Ryabov Andrey Borisovich and Inderpal S. Sarkaria and Alan Dart Loon Sihoe and Takeshi Nagayasu and Takuro Miyazaki and Masayuki Chida and Tadasu Kohno and Agasthian Thirugnanam and Harmic J. Soukiasian and Mark W. Onaitis and Chia-Chuan Liu and on behalf of International Interest Group on Bleeding during VATS Lung Surgery},
title = {International expert consensus on the management of bleeding during VATS lung surgery},
journal = {Annals of Translational Medicine},
volume = {7},
number = {23},
year = {2019},
keywords = {},
abstract = {Intraoperative bleeding is the most crucial safety concern of video-assisted thoracic surgery (VATS) for a major pulmonary resection. Despite the advances in surgical techniques and devices, intraoperative bleeding is still not rare and remains the most common and potentially fatal cause of conversion from VATS to open thoracotomy. Therefore, to guide the clinical practice of VATS lung surgery, we proposed the International Interest Group on Bleeding during VATS Lung Surgery with 65 experts from 10 countries in the field to develop this consensus document. The consensus was developed based on the literature reports and expert experience from different countries. The causes and incidence of intraoperative bleeding were summarised first. Seven situations of intraoperative bleeding were collected based on clinical practice, including the bleeding from massive vessel injuries, bronchial arteries, vessel stumps, and bronchial stumps, lung parenchyma, lymph nodes, incisions, and the chest wall. The technical consensus for the management of intraoperative bleeding was achieved on these seven surgical situations by six rounds of repeated revision. Following expert consensus statements were achieved: (I) Bleeding from major vascular injuries: direct compression with suction, retracted lung, or rolled gauze is useful for bleeding control. The size and location of the vascular laceration are evaluated to decide whether the bleeding can be stopped by direct compression or by ligation. If suturing is needed, the suction-compressing angiorrhaphy technique (SCAT) is recommended. Timely conversion to thoracotomy with direct compression is required if the operator lacks experience in thoracoscopic angiorrhaphy. (II) Bronchial artery bleeding: pre-emptive clipping of bronchial artery before bronchial dissection or lymph node dissection can reduce the incidence of bleeding. Bronchial artery bleeding can be stopped by compression with the suction tip, followed by the handling of the vascular stump with energy devices or clips. (III) Bleeding from large vessel stumps and bronchial stumps: bronchial stump bleeding mostly comes from accompanying bronchial artery, which can be clipped for hemostasis. Compression for hemostasis is usually effective for bleeding at the vascular stump. Otherwise, additional use of hemostatic materials, re-staple or a suture may be necessary. (IV) Bleeding from the lung parenchyma: coagulation hemostasis is the first choice. For wounds with visible air leakage or an insufficient hemostatic effect of coagulation, suturing may be necessary. (V) Bleeding during lymph node dissection: non-grasping en-bloc lymph node dissection is recommended for the nourishing vessels of the lymph node are addressed first with this technique. If bleeding occurs at the site of lymph node dissection, energy devices can be used for hemostasis, sometimes in combination with hemostatic materials. (VI) Bleeding from chest wall incisions: the chest wall incision(s) should always be made along the upper edge of the rib(s), with good hemostasis layer by layer. Recheck the incision for hemostasis before closing the chest is recommended. (VII) Internal chest wall bleeding: it can usually be managed with electrocoagulation. For diffuse capillary bleeding with the undefined bleeding site, compression of the wound with gauze may be helpful.},
issn = {2305-5847}, url = {https://atm.amegroups.org/article/view/33255}
}