Intraoperative conversion from thoracoscopy to thoracotomy in anatomical lung resections

OBJECTIVE. Despite the increasingly use of video-assisted approaches in thoracic surgery, intraoperative conversion from minimally invasive to «open» takes place quite often, especially during anatomical lung resection.  

METHODS AND MATERIALS. A retrospective analysis of 106 consecutive anatomical lung resections (lobectomies) initiated by thoracoscopic access was performed. The patients were divided into two groups: a group of 90 patients without conversion and a group of 16 patients (15%) who required conversion before thoracotomy. We analyzed reasons for conversion, attempted to predict conversion, and estimated the effect of conversion on the postoperative course.  

RESULTS. The reasons for conversions were: absence of an interlobar fissure – 5 (31 %), bleeding – 4 (25 %), discrepancy between the CT and intraoperative situation – 2 (13 %), intrapleural adhesions – 2 (13 %), variant anatomy of pulmonary vessels and bronchi – 2 (13 %), lymph nodes invasion into the main vessels – 1 (6 %). Conversions were divided into «forced» (in order to stop bleeding) and «unforced» (in order to prevent the development of possible intraoperative complications and unjustified prolongation of the duration of the operation). There was no significant difference in the frequency of early postoperative complications in patients after “unforced” conversion and in patients operated according to the plan by thoracoscopy. Prolonged air leakage was noted in 5 out of 16 patients (31.3 %) in the conversion group and in 35 out of 90 patients (38.9 %) in the thoracoscopy group (p=0.28). The severity of the pain syndrome in 24 hours after the surgery assessed by visual analogue scale was also comparable; the average values of pain assessment were 3+2 in the thoracoscopy group and 4+2 in the conversion group (p=0.19).  

CONCLUSION. “Unforced” conversion in thoracoscopic lobectomies is not accompanied by an increasing incidence of postoperative complications; it should be considered as a natural course of the operation in order to prevent intraoperative complications and reduce the duration of the surgery. 

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