Complications - Uniportal VATS Segment-6 Resection Right

• Massive bleeding due to injury of the major vessels, particularly caused by tumor infiltration or inflammatory adherent lymph nodes
  • By compression using a swab, the situation can usually be controlled to the extent that, under continuous compression, the transition to thoracotomy can be managed in a controlled manner without excessive blood loss, and the anesthesia team can be informed, additional instruments prepared, and, if necessary, appropriate assistance organized. Blind clamping and suturing attempts generally increase the damage.
• Parenchymal lesions of the lung during mobilization or in the area of staple lines, especially with obliterated interlobar fissure
  • An attempt at suturing is often frustrating with vulnerable lung tissue or emphysematous lung. Here, the use of staple line reinforcement or a sealing matrix is helpful.
  • In individual cases, the surgeon must decide, based on information from anesthesia, about the fistula volume, whether conservative therapy with chest drainage is also justifiable.
• Injury to the contralateral pleura
  • Especially during the preparation of infracarinal lymph nodes at station 7, 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, main bronchi, or other segmental bronchi
• Injury to the vagus nerve, phrenic nerve, and recurrent laryngeal nerve
• Injury to the esophagus

Cardiac Arrhythmia (10-15%)

Lobar Torsion (0.1-0.3%)

In cases of suspected lobar torsion, immediate confirmation of the diagnosis via CT imaging and prompt surgical revision are essential. If the rotated lobe remains viable, a subpleural fixation suture to the adjacent lobe may be performed. If viability is uncertain or gangrene is present, the affected lobe must be resected.

Postoperative Bronchial Stump Insufficiency (0.5-4%)

Early symptoms may include high fistula output, respiratory or cardiac decompensation, and, in later stages, purulent sputum and fever. Early diagnosis through bronchoscopy is critical for prognosis and management.

For high-risk patients (those with neoadjuvant therapy, diabetes mellitus, or prior ipsilateral surgery), primary coverage of the bronchial stump using a pericardial fat flap is recommended.

Management depends on the extent of the insufficiency and the timing of diagnosis and may involve either endoscopic intervention or reoperation.

Due to the complexity of bronchial fistula or stump insufficiency treatment, care should be provided at a specialized center.

Persistent Air Leak (from postoperative day 8, approximately 8-15%)

Reoperation for a parenchymal fistula is rarely necessary. Conservative management, including patience, attempts to discontinue suction, or chemical pleurodesis, is often sufficient.

Postoperative Pleural Empyema (0.1-2%)

The most common cause is a persistent air leak leading to contamination of the pleural cavity in patients with preexisting immunodeficiency.

Initial treatment consists of adequate drainage and antibiotic therapy. Surgical revision is often required if a persistent bronchopleural fistula is present.

Key measures include early initiation of broad-spectrum antibiotics, bronchial hygiene, bronchoscopic sampling (for microbiology), and intensive physiotherapy.

Hemothorax (requiring transfusion or reoperation, 1-4%)

Immediate surgical revision is indicated for 1 liter of bloody drainage within the first postoperative hour or persistent output of 200-400 mL/hour in the first 5 hours postoperatively.

Chylothorax (0.5-1%)

Initial management is conservative, involving a medium-chain triglyceride (MCT) diet or parenteral nutrition. If chylous drainage persists beyond 14 days, radiological intervention or surgical treatment is indicated.

Vocal Cord Palsy (0-1%)

Management includes speech therapy and otolaryngologic (ENT) consultation.

Nerve Injuries Due to Positioning

Careful intraoperative positioning is essential to avoid nerve damage.