Unanticipated troubles in video-assisted thoracic surgery: a proposal for the classification of troubleshooting

Classification of GLOSSECTOMIES: Proposal for tongue cancer resections

Background

Surgery of tongue tumors includes different procedures ranging from mucosal resection to complex combined resection. Numerous terms have been used to describe such procedures, but there is no consensus between the terminology and the extent of resection.

Methods and Results

We searched the medical literature and found a lack of published information. We undertook to describe a new classification of surgical procedures for tongue tumor resection. We based it upon the surgical anatomy of the tongue and the spread of the cancer. We posited that there were five major types of glossectomy embracing all the methods of tongue cancer resection. This classification was reviewed and endorsed by an international team of experts.

Conclusion

We propose a more precise classification than that currently in practice, thereby bringing clarity and consistency to the terminology, facilitating shared communication between surgeons, comparison between published research, and ultimately improving surgical practice and patient care.

Are There Contraindications for Uniportal Video-Assisted Thoracic Surgery?

Allowing oneself to indulge in illusory superiority when it comes to uniportal video-assisted thoracic surgery (VATS) can harm patients and the specialty. It is important for every VATS surgeon to remain vigilant. One must be clear about the absolute and relative contraindications for VATS: those conditions that should deter from even attempting a uniportal approach. Once the operation is started, one must also bear in mind those situations that should prompt one to convert. Only by first safeguarding patients in this way can the aspiring uniportal VATS surgeon go on to safely master the approach and explore its benefits.

Management of unexpected intraoperative bleeding during thoracoscopic pulmonary resection: a single institutional experience

PURPOSE

Unexpected intraoperative bleeding during thoracoscopic surgery, necessitating emergency conversion to thoracotomy, is gradually being reported. We reviewed our experience of encountering unexpected bleeding during thoracoscopic surgery.

METHODS

We defined "unexpected intraoperative bleeding" as the need for hemostatic procedures with angiorrhaphy, with or without a sealant. The location, cause, and management of injured vessels, and perioperative outcomes were investigated and compared with those for patients without injured vessels.

RESULTS

Between 2007 and 2014, a total of 241 thoracoscopic anatomical pulmonary resections were performed at our hospital. Twenty (8.3 %) of these patients required hemostatic procedures with angiorrhaphy, with or without a sealant. The main injured vessels were the pulmonary artery (n = 13) and vein (n = 3) and the main causes of injury were related to technical issues with energy devices and staplers. There were no morbidities related to intraoperative bleeding. The operation time and blood loss were significantly greater in the patients with vessel injury than in those without vessel injury, but perioperative morbidities and the duration of chest tube insertion (4.5 vs. 3.5 days, average, p = 0.20) and postoperative hospital stay (12.7 vs. 11.0 days, average, p = 0.08) were not significantly different.

CONCLUSIONS

The frequency of unexpected bleeding was relatively high in this series, but its management and outcomes were satisfactory in terms of safety.