Right Main Pulmonary Artery Bleeding Control with Uniportal VATS

A fifty-one-year-old female patient was admitted to the hospital for a second opinion regarding surgical intervention. She had been diagnosed with small cell lung carcinoma of the right upper lobe that was crossing the oblique fissure. Previously, she underwent treatment with multiple cycles of chemo and radiotherapy with a good initial response. The treatment was discontinued because of severe thrombopenia.

The surgical team decided to perform a right pneumonectomy using uniportal VATS. First, a 3 cm incision was placed between the right anterior and midaxillary lines. The hilar dissection was complicated because of fibrosis. Unfortunately, major bleeding was caused to the right main pulmonary artery during the dissection of the vascular structures. Keeping calm and initial bleeding control by applying pressure with a surgical sponge or swab was critical. 

After assessing the situation, the team decided to open the pericardium in front of the upper vena cava, and dissect and retract it to access the proximal part of the right PA. After dissecting the right PA under SVC, the artery was clamped. Then, the team proceeded to release the pressure and assess the damage. Some noncritical retrograde bleeding was observed but didn't intervene with further dissection of the right PA. The artery was transected using a mechanical stapler. After this step, the clamp was released. No further bleeding was observed, and the right pneumonectomy was performed in the usual order.

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