Technical strategy for dealing with bleeding during thoracoscopic lung surgery.

Uncontrollable bleeding caused by vascular injury is an important reason for conversion to thoracotomy during thoracoscopic lung surgery. Demmy et al. (1) summarized several effective methods for dealing with bleeding, such as the use of thrombostatic material, biological sealant, or discreet utilization of energy sources. However, managing more severe bleeding is quite challenging even for experienced thoracoscopic surgeons. The most common solution for this situation is compression or tamponade of the injured site while converting to open thoracotomy (1,2). We have previously described a series of skills named the “suction-compressing angiorrhaphy technique (SCAT)” for dealing with severe bleeding due to vascular injury during thoracoscopic lung surgery (3). Bleeding control and angiorrhaphy were both achieved through thoracoscopy in most of the cases of vascular injury in our center. Here, we present our technical strategy for dealing with bleeding and vascular injury during thoracoscopic lung surgery with a video series.