gms | German Medical Science

Background: Thoracoscope is essential instrument for video-assisted thoracoscopic surgery (VATS) and keeping the clear view during operation is essential for safe and high quality operation. However, perioperative vision disturbance during VATS by blood oozing from wound edge of access port often stresses the surgeons and it takes extra time for them to clean up the thoracoscope. To eliminate the bothersome matter, we show the new technique to prevent the blood oozing from wound using oxidized regenerated cellulose (Nu-Knit; Ethicon, Johnson & Johnson, Somerville, NJ).

Materials and methods: We reviewed 57 consecutive cases who underwent resection of lung or mediastinual tumor under pure VATS. The incision is 1 window and 2 or 3 ports. First, the sheet of oxidized regenerated cellulose was cut into 1.5 cm×13cm (window), 1.5cm×8cm（port）and they were rolled around wound edge protector (lap protector, Hakkou Co., Nagano, Japan) (Fig.1). After the preparation, a window and ports were made and wound edge protector with oxidized regenerated cellulose were put for them (Fig.2). After oxidized regenerated cellulose was adjusted to cover wound edge, intrathoracic procedure was started. After the intrathoracic procedure, oxidized regenerated cellulose and lap protectors were removed then the wound was closed.

Results: During intrathoracic procedure, our new technique dramatically reduced the stress of vision disturbance due to blood oozing. Fifty five cases among 57 cases (96.5%) were never needed to stop the procedure for cleaning of thoracoscope. Another 2 cases were also unneeded to do it by additional usage of oxidized regenerative cellulose sheet after vision disturbance. Furthermore, hemostasis for the wound edge was unnecessary for most cases (93%) because oxidized regenerated cellulose sheet stopped bleeding of wound edge completely during intrathoracic procedure. No cases have wound trouble including wound infection.

Conclusion: In our series, hemostasis of wound edge before wound closure was needed in 4 cases. Insufficient contact between wound edge and oxidized regenerated sheet is considered possible reason of the necessity of hemostasis. Further improvement of sheet placement especially for patients whose chest wall is thick is necessary in the future. Our new technique is extremely simple as well as small in cost. It can be applied for other type of wound edge protectors because of the simplicity. We are convinced our convenient approach would bring great contribution to thoracic surgeons who have enthusiasm for the quality of VATS.