Intraoperative Bronchial Perforation Caused by Soft Coagulation —A Case Report—

Abstract

A 72-year-old woman presented to our hospital with an abnormal finding at a chest X-ray during physical examination. Chest computed tomography incidentally showed a 2.3-cm diameter tumor in the right pulmonary lower lobe. The patient underwent thoracoscopic right lower lobe lobectomy for lung adenocarcinoma. During a regional lymphrode dissection, bleeding occurred from the bronchial artery around the middle bronchus, and soft coagulation was performed using ball electrode coagulation. We had difficulties with hemostasis and needed frequent use of the hemostat system. The middle bronchus at where soft coagulation was performed revealed an ischemic change and perforation of the wall. This was probably caused by thermal damage from soft coagulation. The perforated area was repaired by direct suture and covered with a pericardial fat pad. The thoracic drain was removed on the 1^st postoperative day and she was discharged 3 days after surgery. At 10 months after surgery, the patient walks on foot, and has no recurrence. Soft coagulation is a hemostat system of electrosurgical units, which automatically regulates its output voltage below 200V, to avoid excessive output that causes carbonization of the target tissue. Soft coagulation is an effective device for hemostasis, but it can cause thermal damage to the deep organs and should be used with a proper understanding of the characteristics of the device.