Bleeding Control by Uniportal VATS Right Upper Lobectomy

In experienced thoracoscopic surgeons, Intraoperative bleeding occurred more frequently during advanced and postchemotherapy VATS lobectomy cases than in early stage tumors. Most of bleeding from pulmonary arteries and veins can be controlled by compression, and they can be controlled thoracoscopically by tie or suture through the utility thoracotomy. In this video we present a complex VATS lobectomy, big right upper lobe tumor, treated with chemotherapy, and proposed for uniportal thoracoscopic approach. During the dissection over the pulmonary artery, once the truncus anterior and upper vein were stapled, bleeding happened from a recurrent branch. The strategy was planned in three different steps: compression, division of the anterior and posterior fissure and put vascular clips (click aV, Grena) on the recurrent branch, two proximally and one distally. Finally the bronchus was divided and the specimen removed in a protective bag. Diego Gonzalez-Rivas, MD, FECTS Minimally Invasive Thoracic Surgery Unit (UCTMI) and Coruña University Hospital, Coruña, Spain