Clinical study of intraoperative conversion from video-assisted thoracoscopic surgery lobectomy to open thoracotomy in pulmonary tuberculosis

Objective To discuss the causes of non-planned conversion to thoracotomy in VATS lobectomy for pulmonary tuberculosis and analyze the influence of non-planned conversion to thoracotomy on surgical safety.Methods The data of 113 patients who underwent lobectomy due to tuberculosis from January 2015 to June 2018 were retrospectively analyzed,and their average age was 39.55±14.20 years old.There were 49 cases in the thoracoscopic group and 64 cases in the thoracotomy group,and among them,the thoracotomy group was divided into the non-planned conversion to thoracotomy group(14 cases)and the planned thoracotomy group(50 cases).The cause of conversion to thoracotomy was recorded.The operative time,intraoperative blood loss,postoperative drainage volume,postoperative extubation time,postoperative hospitalization time,postoperative complications and other indicators were compared among the groups.Results During thoracoscopic surgery,the rate of conversion to thoracotomy was 22.2%(14/63).The rate of elected to open with anticipation of difficulties was 71.4%(10/14).The rate of controlled and opened following difficulty was 21.4%(3/14)and the rate of uncontrolled open with emergency was 7.1% (1/14). Reasons for conversion to thoracotomy included vascular injury (21.4%, 3/14), anatomy (42.9%, 6/14), lymph nodes (28.6%, 4/14), and technical (7.1%, 1/14). Compared to the thoracotomy group, the VATS group had shorter operation time (207.14±65.56 VS 265.63±93.99min, t=3.717, P< 0.001), less amount of intraoperative blood loss [400 (100, 1600) VS 800 (200, 3400) ml, Z=-4.908, P< 0.001], less postoperative drainage [800 (125, 2175) VS 1227.5 (410, 3250) mL, Z=-3.955, P< 0.001], less extubation time [5 (2, 19) VS 7 (2, 26) d, Z=-3.662, P< 0.001] and shorter hospital stay (13.08±4.39 VS 19.13±7.72d, t=5.252, P< 0.001). There was no statistical difference in postoperative complications (11 VS 16, χ^2=0.099, P =0.753) between the two groups. At the same times, there was no statistical difference in operation time (253.80±89.14