Method to transect pulmonary arteries and experience of pulmonary artery injury based on nationwide survey of Japanese thoracic surgeons

Injury of the pulmonary artery is a severe incident that sometimes occurs during pulmonary lobectomy. The action taken in response to it is left to the discretion of each surgeon and has not been standardized. A survey was performed on the method of transecting pulmonary arteries (PA) and response to PA injury involving 719 active members of the Japanese Association of Chest Surgery (JACS), and 418 (58.1%) provided viable responses. Eighty-two percent of the responders chose video-assisted thoracic surgery for pulmonary lobectomy. At the time of transection of the right A1+3 (approximately 9 mm in diameter), 92.6% used automatic stapling devices. For the left A3 (approximately 6 mm in diameter), 83.3% used automatic stapling devices and 8.4% favored double ligatures. For the right A2b (approximately 3 mm in diameter), 65.6% used single ligation and an energy device (or surgical clip) and 21.3% favored double ligatures. The majority of the responders had encountered blood loss of more than 500 mL, a half had considered conversion from VATS to thoracotomy when blood loss exceeded 500 mL, and one fourth had introduced cardiopulmonary bypass during hemostatic procedures in patients with PA injury. The common method of PA transection and response to PA injury were shown in this questionnaire survey.