Management of bleeding complications during thoracoscopic thymectomy

Video-assisted thoracoscopic thymectomy is increasingly performed for thymic disorders. However, intraoperative bleeding, especially from the innominate vein, is often inevitable, and is the major reason for conversion. Successful control under thoracoscopic thymectomy is crucial for the safety of the patient. We hereby report two cases of intraoperative bleeding and strategies for safe and effective bleeding control during the conventional three-port video-assisted thoracoscopic thymectomy. The first case was an 80-year-old male patient diagnosed with cystic thymoma, and injury to a thymic vein below the left innominate vein occurred during a right thoracoscopic thymectomy. It was well managed by endovascular clips under video-assisted thoracoscopic thymectomy. The intraoperative blood loss was 50 mL. The second case was a 73-year-old female patient diagnosed with thymoma. Massive bleeding from the left innominate vein occurred due to inadvertent injury during a left approach thoracoscopic thymectomy. But it was successfully controlled via endoscopic stapler. Intraoperative blood loss was 300 mL and the patient did not receive any blood transfusion. Postoperative courses of both two cases were uneventful. Our experience shows that endoscopic clipping or stapling respectively can provide safe, quick, and effective control of different types of bleedings under video-assisted thoracoscopic thymectomy. This technique is helpful to ensure the safety and success of minimally invasive surgery for thymic diseases.