Iatrogenic bronchial injury findings during video-assisted thoracoscopic surgery
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CASE REPORT
Iatrogenic bronchial injury findings during video‑assisted thoracoscopic surgery Yuya Ishikawa1 · Tetsu Yamada1 · Mitsuhiro Ueda1 · Shinjiro Nagai1 · Yoshihiro Miyamoto1 Received: 10 June 2020 / Accepted: 16 August 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Iatrogenic tracheobronchial injury detected during cardiothoracic surgery should be repaired intraoperatively to ensure safe of postoperative management and stable respiratory conditions. We report herein a patient with lung cancer who underwent video-assisted thoracoscopic surgery right lower lobectomy. During surgery, pneumomediastinum and air leakage from mediastinal fatty tissue were detected. Furthermore, bronchial injury to the membranous part of the left main bronchus was incidentally detected. Hence, we switched from video-assisted thoracoscopic surgery to posterolateral thoracotomy and repaired this bronchial injury using a continuous suture technique under right femoral venoarterial extracorporeal membrane oxygenation support. The intraoperative findings could offer a clue for early detection and development of therapeutic strategy for iatrogenic tracheobronchial injury. Keywords Iatrogenic bronchial injury · Patient safety · Extracorporeal membrane oxygenation support
Introduction Iatrogenic tracheobronchial injury (ITI) is a rare life-threatening event associated with significant morbidity and mortality [1]. In particular, ITI detected during cardiothoracic surgery is an indication for surgical repair [1–3]. This injury should be recognized and repaired intraoperatively to ensure safety of postoperative management and stable respiratory conditions [4]. We report here two characteristic intraoperative manifestations of ITI during a video-assisted thoracoscopic surgery (VATS), namely, pneumomediastinum and air leakage through the fatty tissue.
Case A 77-year-old woman with a nodule in the right lower lobe was referred to our department. Her medical history included significant hypertension and infantile paralysis. She had an Eastern Cooperative Oncology Group performance * Yuya Ishikawa [email protected] 1
Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, 68 Honmachi, Himeji, Hyogo 670‑8520, Japan
status of one. Chest computed tomography (CT) detected a solid 28-mm nodule in the right lower lobe. Bronchoscopy confirmed the presence of adenocarcinoma. 18F-fluorodeoxyglucose positron emission tomography/computer tomography (18F-FDG-PET/CT) revealed significant FDG uptake in the main lesion and the right hilar lymph node (cT1cN1M0, cStageIIB). Pulmonary function tests showed a forced vital capacity of 154.9%, a forced expiratory volume-one second (FEV1) of 169.7%, and an FEV1% of 80.5%. Thus, right lower lobectomy using a complete VATS approach was planned. After induction of anesthesia, the patient was intubated with a left-sided double-lumen endobronchial tube to establish differential lung ventilation and her surgical position was changed into the left decubitus
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