- Massive bleeding due to injury of major vessels, particularly caused by tumor infiltration or inflammatory adhesion of 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, allowing for the notification of anesthesia, preparation of additional instruments, and, if necessary, the organization of adequate assistance. 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 the anesthesiologist's information about the fistula volume, whether conservative therapy with chest drainage is also acceptable.
- Injury to the contralateral pleura
- Particularly during the dissection of infracarinal lymph nodes at 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, main bronchi, or other segmental bronchi
- Injury to the vagus nerve, phrenic nerve, and recurrent laryngeal nerve
- Injury to the esophagus
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Intraoperative Complications
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Postoperative Complications
- Cardiac arrhythmia (10-15%)
- Lobe torsion (0.1-0.3%)
- In case of suspicion, immediate diagnostic confirmation using CT imaging and surgical revision. If the rotated lobe still appears viable, a subpleural fixation suture to the adjacent lobe is possible. In cases of unclear viability or gangrene, the respective lobe must be removed.
- Postoperative bronchial stump insufficiency (0.5-4%)
- Early symptoms can include high fistula volumes, respiratory or cardiac decompensation, with purulent sputum and fever in the later course. Early diagnostic confirmation using bronchoscopy is crucial for prognosis and course.
- In patients at risk (neoadjuvant pre-treatment, diabetes mellitus, ipsilateral previous surgery), primary coverage of the bronchial stump with a pericardial fat pad is recommended.
- The therapy depends on the extent of the insufficiency and the timing of diagnosis and can be either endoscopic or involve re-operation.
- The treatment of bronchial fistula or stump insufficiency is complex and should be performed at a specialized center.
- Persistent air fistula (from the 8th postoperative day, approximately 8-15%)
- A revision surgery due to a parenchymal fistula is very rarely required. Conservative therapy (with patience, suction release attempt, or chemical pleurodesis) is often sufficient.
- Postoperative pleural empyema (0.1-2%)
- The most common cause is a 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. Surgical revision is often required in the case of a persistent bronchopleural fistula.
- The most important measures, in addition to 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 1-4%)
- Immediate surgical revision in the case of 1L of bloody secretion in the first hour post-operation or persistent output of 200-400ml/h in the first 5 hours post-operation.
- Chylothorax (0.5-1%)
- Initially conservative therapy using MCT diet or parenteral nutrition. In case of persistent secretion over 14 days, radiological intervention or surgery is indicated.
- Vocal cord paralysis (0-1%)
- Speech therapy and ENT specialist co-management.
- Nerve lesions due to positioning injuries