Management of intra-operative major bleeding during single-port video-assisted thoracoscopic anatomic resection: two-center experience

Background Our objective is to report on two centers’ experience of intra-operative management of major vascular injury during single-port video-assisted thoracoscopic (SPVATS) anatomic resections, including bleeding control techniques, incidence, results, and risk factor analysis. Methods Consecutive patients ( n = 442) who received SPVATS anatomic lung resections in two centers were enrolled. The different clinical parameters studied included age, previous thoracic surgery, obesity (BMI > 30), tumor location, neoadjuvant therapy, and pleural symphysis. In addition, peri-operative outcomes were compared between the groups, with or without vessel injury. Results There were no intra-operative deaths in our study. Overall major bleeding incidence was 4.5%, whereby 70% of major bleeding episodes could be managed with SPVATS techniques. In order to determine risk factors possibly related to intra-operative bleeding, we used case control matching to homogenize our study population. After case control matching, pleural symphysis was significantly related in the univariate ( p = 0.005, Odds ratio 4.415, 95% CI 1.424–13.685) and multivariate analysis ( p = 0.006, Odds ratio 4.926, 95% CI 1.577–15.384). Operative time ( p