Limits and complications of mini-invasive surgery of major pulmonary resections

A personal series of 67 major pulmonary resections (62 lobectomies, 4 pneumonectomies, 1 segmentectomy) and 7 other converted procedures is reviewed. Conversions, technical difficulties and intra and postoperative complications mainly consisted of: pleural adhesions, incomplete fissures, vascular and bronchial isolation-section, inedequacy of instrmentation. In the reported series, a major problem and often cause of conversion was isolation of the artery within the fissure when the latter is incomplete, poorly developed or sealed. Current instruments must be improved and new endoscopic devices for thoracic use may be useful. Post-operative complications do not differ from open surgery.