Video-Assisted Thoracoscopic Surgery for Postoperative Hemothorax

Abstract

Background: The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in the treatment of postoperative bleeding after thoracic surgery. Methods: We retrospectively analyzed data from our institution on the use of a video-assisted approach in patients requiring reexploration for hemorrhage occurring after open or VATS procedures. Results: Seventeen surgical reexplorations were performed in 16 patients: 7 after VATS and 9 after prior open procedures. The interval between the end of the first procedure and reexploration was 6–36 hours after VATS and 15–120 hours after thoracotomy. The source of bleeding was identified in 82.4 % of cases. No deaths occurred. The postoperative course was uneventful for all patients except one, who underwent extrapleural pneumonectomy and required a second VATS reexploration for uncontrolled bleeding 10 hours after the first reoperation. Conclusions: The videothoracoscopic approach for postoperative hemothorax requiring surgical reexploration seems to be safe and effective and guarantees the benefits of minimally invasive surgery: it allows the surgeon to evacuate the hemothorax, to accurately explore the operating field, and to achieve adequate hemostasis.

Key words

thoracoscopy/VATS - hemothorax - reoperation - postoperative complications

References

• 1 Harpole Jr D H, DeCamp Jr M M, Daley J et al. Prognostic models of thirty-day mortality and morbidity after major pulmonary resection.  J Thorac Cardiovasc Surg. 1999;  117 969-979
• 2 Schipper P H, Nichols F C, Thomse K M et al. Malignant pleural mesothelioma: surgical management in 285 patients.  Ann Thorac Surg. 2008;  85 257-264
• 3 Imperatori A, Conti V, Rotolo N et al. Peri-operative complications of video-assisted thoracoscopic surgery (VATS).  Int J Surg. 2008;  6 578-581
• 4 Solaini L, Prusciano F, Bagioni P, DiFrancesco F, Solaini L, Poddie D B. Video-assisted thoracic surgery (VATS) of the lung. Analysis of the intraoperative and postoperative complications in 15 years and review of the literature.  Surg Endosc. 2008;  22 298-310
• 5 Landreneau R J, Keenan R J, Hazelrigg S R, Mack M J, Maunheim K S. Thoracoscopy for empyema and hemothorax.  Chest. 1996;  109 18-24
• 6 Lang-Lazdunski L, Mouroux J, Pons F et al. Role of videothoracoscopy in chest trauma.  Ann Thorac Surg. 1997;  63 327-333
• 7 Meyer D M, Jessen M E, Wait M A. Early evacuation of traumatic retained hemothoraces using thoracoscopy: a prospective, randomized trial.  Ann Thorac Surg. 1997;  64 1396-1401
• 8 Ahmed N, Jones D. Video-assisted thoracic surgery: state of the art in trauma care.  Injury. 2004;  35 479-489
• 9 Solaini L, Prusciano F, Bagioni P. Video-assisted thoracic surgery in the treatment of pleural empyema.  Surg Endosc. 2007;  21 280-284
• 10 Péterffy A, Henze A. Haemorragic complications during pulmonary resection.  Scand J Thorac Cardiovasc Surg. 1983;  17 283-287
• 11 Sirbu H, Busch T, Aleksic I, Lotfi S, Ruschewski W, Dalichau H. Chest re-exploration for complications after lung surgery.  Thorac Cardiovasc Surg. 1999;  47 73-76
• 12 Craig S R, Leaver H A, Yap P L, Pugh G C, Walker W S. Acute phase responses following minimal access and conventional thoracic surgery.  Eur J Cardiothorac Surg. 2001;  20 455-463