Abstract
We analyzed intraoperative troubles associated with 834 patients who underwent thoracoscopic/video-assisted thoracic surgery (TS/VATS) in our institution from January, 1995 to January, 2006. The causes of 17 of the 25 intraoperative troubles were operators' errors, followed by 4 trouble shootings of stapling instruments. Including the 3 miss-choice of the stapling instruments and one assistant's error, the causes of 21 (84%) of the intraoperative troubles were surgeons' errors. However, almost of them were considered to be derived from the specific TS/VATS-related surgical handicaps. Conversion to open thoracotomy was needed in 4 (1.0%) of 416 TS-patients and in 3 (0.7%) of 418 VATS-patients. Two cases of life-threatening major vascular injuries were encountered, which might have been fatal without a small thoracotomy routinely placed in our VATS. There were no operative deaths in our TS/VATS patients. It is therefore recommended to place an access thoracotomy in VATS so that surgeons can safely manage unexpected events, resulting in successful completion of the anatomical pulmonary resection associated with vascular dissection. In conclusion, it is essential to build up a system of reporting intraoperative troubles in TS/VATS in order to share information and provide a data base to aid risk management.
