Handling Vascular Injuries in Robotic Thoracic Surgery: Real-Life Cases Using a Fibrin-Based Hemostatic Technique

Vascular injuries during robotic thoracic surgery are rare but potentially life-threatening. Prompt control of bleeding is essential to avoid hemodynamic instability and the need for conversion to open surgery. This video presents a practical technique for managing vascular injuring using a collagen-based hemostatic patch while preserving the minimally invasive approach. 
 
The patch consists of an absorbable equine collagen sponge coated with human fibrinogen and thrombin. When applied to a dry field, it activates the coagulation cascade upon contact with blood, promoting localized clot formation. It is effective for both arterial and venous bleeding, especially in robotic settings where suturing may be technically limited. 
 
The technique includes initial compression, quick preparation and placement of the patch using the robotic arm, and sustained compression for three to five minutes to ensure adhesion. This video demonstrates three cases: arterial, venous, and subclavian vein bleeding. In all cases, hemostasis was achieved without the need for conversion, and the patients recovered uneventfully. 
 
This fibrin-based strategy provides a safe, reproducible, and efficient method for controlling vascular bleeding during robotic lung resections, enabling surgeons to maintain the benefits of a minimally invasive approach even in high-risk scenarios. 

References

1. Baste JM, et al. Implementation of simulation-based crisis training in robotic thoracic surgery: how to improve safety and performance? J Thorac Dis . 2021 Aug;13(Suppl 1):S26-S34. doi: 10.21037/jtd-2020-epts-03
2. Novellis et al. Management of robotic bleeding complications. Ann Cardiothorac Surg 2019;8(2):292-295
3. Cheufou D, Ilias A, Gronostayskiy M (2023) Preventing and Managing Intraoperative Catastrophic Bleeding in Robotic Lung Cancer Lobectomy: “Life-Saving Strategies”. J Surg 8: 1947 DOI: 10.29011/2575-9760.001947

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