Complications - Anterolateral thoracotomy - general and visceral surgery
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Injury to intercostal nerves and vessels
This complication can be avoided either by dissecting strictly along the superior aspect of the rib or, as demonstrated in the present case, by bringing down the nerve at the inferior aspect of the rib under direct vision, since the intercostal neurovascular bundle courses along the inferior aspect. In case of any bleeding, secure the vessel with a suture ligature or clip since sealing by electrocautery alone is not reliable enough.
In case of a rib fracture, smooth any sharp projections with a bone rongeur, as they could puncture the lung.
Bleeding when taking down pleural adhesions
→ Seal with electrocautery, hemostatics
Bleeding from a pulmonary vessel
→ punctiform coagulation or targeted clamping with a hemostat and then suture ligature, otherwise the tear will expand, and the ligature will slip off; alternatively, tangential clamping with an atraumatic Satinsky forceps and closure with atraumatic sutures.
Acute airway obstruction
→ intraoperative bronchoscopy
due to irritation of the vagus or phrenic nerve
Persistent pulmonary parenchymal leakage
resulting from tears during dissection → close the pleural margins with U-stitches