Risk factors for vascular oozing or bleeding following transection with automatic staplers during uniportal video-assisted thoracoscopic surgery.

OBJECTIVE

To investigate the risk factors for vascular oozing or bleeding after vessel transection with automatic staplers during uniportal video-assisted thoracoscopic surgery (VATS).

METHODS

Among 157 consecutive uniportal anatomical lung resections performed between December 2018 and December 2023, 117 cases involving vascular stapling were retrospectively reviewed. A five-grade blood leakage scale (Grades 0-4) was used to assess both proximal and distal vessel stumps.

RESULTS

Among 446 transected vessels, Grade 2 blood leakage occurred in 39 sites (8.7%) and Grade 3 in seven sites (1.6%). No Grade 4 bleeding or secondary injuries were observed. Multivariate analysis revealed body height ≤ 160 cm (odds ratio [OR] 4.7, p = 0.004) and left upper lobe vessels (OR 11.9, p = 0.002) as independent risk factors for Grade ≥ 2 blood leakage. Detailed vessel-level analysis further revealed that the proximal stump of the first branch of the left upper lobe most frequently required hemostatic intervention (11 sites; 24%).

CONCLUSIONS

This study is the first to report that short stature and left upper lobe vessels are risk factors for Grade ≥ 2 blood leakage during uniportal VATS. Although Grade 2 bleeding is not critical, it may serve as a precursor to Grade 3 or more severe bleeding. Therefore, surgical procedures should be performed with careful consideration of these potential risks.