Response to intraoperative bleeding during video-assisted thoracoscopic surgery

Minimally-invasive surgeries including video-assisted thoracoscopic surgery and robot-assisted thoracoscopic surgery are used throughout the world and are one of the standard approaches to primary lung cancer and other chest diseases. The clinical utility of those surgeries has improved owing to advances in thoracoscopic instruments and techniques; however, it is also increasingly important for thoracic surgeons to know how to manage unexpected intraoperative bleeding during these surgeries, particularly thoracoscopic surgeries. In this review, we outline the essentials to perform safe thoracoscopic surgery, showing specific methods for controlling bleeding and repairing the injured vessels. In addition, we discuss indications and timings of conversion to open thoracotomy and show the algorithm of management for unexpected intraoperative bleeding during video-assisted thoracoscopic surgery.