Risk factors for vascular oozing or bleeding following transection with automatic staplers during uniportal...

To investigate the risk factors for vascular oozing or bleeding after vessel transection with automatic staplers during uniportal video-assisted thoracoscopic surgery (VATS).

Among 157 consecutive uniportal anatomical lung resections performed between December 2018 and December 2023, 117 cases involving vascular stapling were retrospectively reviewed. A five-grade blood leakage scale (Grades 0-4) was used to assess both proximal and distal vessel stumps.

Among 446 transected vessels, Grade 2 blood leakage occurred in 39 sites (8.7%) and Grade 3 in seven sites (1.6%). No Grade 4 bleeding or secondary injuries were observed. Multivariate analysis revealed body height ≤ 160 cm (odds ratio [OR] 4.7, p = 0.004) and left upper lobe vessels (OR 11.9, p = 0.002) as independent risk factors for Grade ≥ 2 blood leakage. Detailed vessel-level analysis further revealed that the proximal stump of the first branch of the left upper lobe most frequently required hemostatic intervention (11 sites; 24%).

This study is the first to report that short stature and left upper lobe vessels are risk factors for Grade ≥ 2 blood leakage during uniportal VATS. Although Grade 2 bleeding is not critical, it may serve as a precursor to Grade 3 or more severe bleeding. Therefore, surgical procedures should be performed with careful consideration of these potential risks.