Bleeding Control by Uniportal VATS in a Complex Tumor with Abnormal Artery

We report a challenging case of a complex tumor operated by uniportal VATS with profuse bleeding from an abnormal artery managed with no conversion to thoracotomy. A single 4 cm skin incision was made in the 5th intercostal space. The surgeon and assistant were positioned in the front of the patient. The 30˚ high definition thoracoscope, specially designed curved Thoracoscopic instruments, and vascular polymer clips were used. During the surgery the camera was placed in the posterior part of the incision and the instruments were placed below the camera, Upon entering the cavity it became apparent that the diaphragm was very high, severe adhesions of the lung to the chest wall and mediastinum and small thoracic cavity
All these findings presented extreme technical difficulties with visualization, instrumentation and dissection. Isolation and separation of vascular structure and bronchus was a most daunting and difficult task, while developing the minor fissure by advancing the stapler above the main arterial trunk a profuse bleeding appeared from an abnormally located S6 branch to the superior segment of the right lower lobe which had arise in a common trunk with S2 arterial branch. Bleeding control was achieved through uniportal VATS avoiding a Thoracotomy.
Lower and middle Lobectomy with mediastinal lymphadenectomy were performed. The lung was extracted in a protective bag. A single chest tube was inserted through the same incision and placed posteriorly at the end of the procedure. The patient was extubated at the conclusion of surgery and transferred to the recovery ward
The recovery of the patient was uneventful, she consumed a small amounts of analgesics during her stay, mobilization started at the same day of the surgery, removal of the chest tube was done in POD #4 and was discharged the following day.
Dr Gonzalez Rivas
Dr Daniel Fink
Dr Abu Akar