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Complications - Uniportal VATS mediastinal lymphadenectomy right

thoracic
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative Complications

    • Bleeding due to injury of smaller branches of the lymph node supplying vessels
    • Parenchymal lesions of the lung during mobilization
    • Injury to the contralateral pleura
      • Especially during the preparation of infracarinal lymph nodes of station 7, an unnoticed opening of the contralateral mediastinal pleura can lead to tension pneumothorax. It is important to recognize the situation and either open the pleura widely or insert a chest drain on the opposite side.
    • Injury to the tracheal wall and main bronchi
    • Injury to the vagus nerve, phrenic nerve, and recurrent laryngeal nerve
    • Injury to the esophagus

  2. Postoperative Complications

    • Cardiac arrhythmia
    • Persistent air fistula (from the 8th postoperative day)
      • A revision surgery due to a parenchymal fistula is very rarely required. Often, conservative therapy (with patience, suction release attempt, or chemical pleurodesis) is sufficient.
    • Postoperative pneumonia, sputum retention, respiratory insufficiency
    • Postoperative pleural empyema
      • The most common cause is the persistent air fistula with contamination of the pleural cavity in the presence of a pre-existing immune deficiency.
      • The therapy initially consists of adequate drainage and antibiotic therapy. An operative revision is often required in the case of a persistent bronchopleural fistula.
      • The most important measures, in addition to the rapid initiation of therapy with broad-spectrum antibiotics, are bronchial toilet and bronchoscopic material collection (microbiology) as well as intensive physiotherapy.
    • Hemothorax (with necessary transfusion or re-operation)
      • Immediate surgical revision in the case of 1L of bloody secretion in the first hour after surgery or persistent drainage amounts of 200-400ml/h in the first 5 hours after surgery.
    • Chylothorax
      • Initially conservative therapy using MCT diet or parenteral nutrition. If secretion persists for over 14 days, radiological intervention or surgery is indicated.
    • Vocal cord paresis
      • Speech therapy and ENT medical co-management.
    • Nerve lesions due to positioning damage