000095876 001__ 95876
000095876 005__ 20211201113715.0
000095876 0247_ $$2doi$$a10.21037/atm.2019.11.142
000095876 0248_ $$2sideral$$a116771
000095876 037__ $$aART-2019-116771
000095876 041__ $$aeng
000095876 100__ $$aLiu, LX
000095876 245__ $$aInternational expert consensus on the management of bleeding during VATS lung surgery
000095876 260__ $$c2019
000095876 5060_ $$aAccess copy available to the general public$$fUnrestricted
000095876 5203_ $$aIntraoperative 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.
000095876 540__ $$9info:eu-repo/semantics/openAccess$$aby-nc-nd$$uhttp://creativecommons.org/licenses/by-nc-nd/3.0/es/
000095876 590__ $$a3.297$$b2019
000095876 591__ $$aONCOLOGY$$b122 / 244 = 0.5$$c2019$$dQ2$$eT2
000095876 591__ $$aMEDICINE, RESEARCH & EXPERIMENTAL$$b65 / 138 = 0.471$$c2019$$dQ2$$eT2
000095876 592__ $$a1.089$$b2019
000095876 593__ $$aMedicine (miscellaneous)$$c2019$$dQ1
000095876 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion
000095876 700__ $$aMei, JD
000095876 700__ $$aHe, J
000095876 700__ $$aDemmy, TL
000095876 700__ $$aGao, SG
000095876 700__ $$aLi, SQ
000095876 700__ $$aHe, JX
000095876 700__ $$aLiu, Y
000095876 700__ $$aHuang, YC
000095876 700__ $$aXu, SD
000095876 700__ $$aHu, J
000095876 700__ $$aChen, L
000095876 700__ $$aZhu, YM
000095876 700__ $$aLuo, QQ
000095876 700__ $$aMao, WM
000095876 700__ $$aTan, QY
000095876 700__ $$aChen, C
000095876 700__ $$aLi, XF
000095876 700__ $$aZhang, Z
000095876 700__ $$aJiang, GN
000095876 700__ $$aXu, L
000095876 700__ $$aZhang, LJ
000095876 700__ $$aFu, JH
000095876 700__ $$aLi, H
000095876 700__ $$aWang, Q
000095876 700__ $$aLiu, DR
000095876 700__ $$aTan, LJ
000095876 700__ $$aZhou, QH
000095876 700__ $$aFu, XN
000095876 700__ $$aJiang, ZM
000095876 700__ $$aChen, HQ
000095876 700__ $$aFang, WT
000095876 700__ $$aZhang, X
000095876 700__ $$aLi, Y
000095876 700__ $$aTong, T
000095876 700__ $$aYu, ZT
000095876 700__ $$aLiu, YY
000095876 700__ $$aZhi, XY
000095876 700__ $$aYan, TS
000095876 700__ $$aZhang, XY
000095876 700__ $$aPu, Q
000095876 700__ $$aChe, GW
000095876 700__ $$aLin, YD
000095876 700__ $$aMa, L
000095876 700__ $$aEmbun, R
000095876 700__ $$0(orcid)0000-0003-0249-3104$$aAragon, J$$uUniversidad de Zaragoza
000095876 700__ $$aEvman, S
000095876 700__ $$aKocher, GJ
000095876 700__ $$aBertolaccini, L
000095876 700__ $$aBrunelli, A
000095876 700__ $$aGonzalez-Rivas, D
000095876 700__ $$aDunning, J
000095876 700__ $$aLiu, HP
000095876 700__ $$aSwanson, SJ
000095876 700__ $$aBorisovich, RA
000095876 700__ $$aSarkaria, IS
000095876 700__ $$aSihoe, ADL
000095876 700__ $$aNagayasu, T
000095876 700__ $$aMiyazaki, T
000095876 700__ $$aChida, M
000095876 700__ $$aKohno, T
000095876 700__ $$aThirugnanam, A
000095876 700__ $$aSoukiasian, HJ
000095876 700__ $$aOnaitis, MW
000095876 700__ $$aLiu, CC
000095876 7102_ $$11004$$2090$$aUniversidad de Zaragoza$$bDpto. Cirugía,Ginecol.Obstetr.$$cÁrea Cirugía
000095876 773__ $$g7, 23 (2019), 712 [12 pp]$$pAnn. transl. med.$$tANNALS OF TRANSLATIONAL MEDICINE$$x2305-5839
000095876 8564_ $$s210129$$uhttps://zaguan.unizar.es/record/95876/files/texto_completo.pdf$$yVersión publicada
000095876 8564_ $$s631441$$uhttps://zaguan.unizar.es/record/95876/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada
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000095876 951__ $$a2021-12-01-11:34:49
000095876 980__ $$aARTICLE