Bronchoscopic Intra-Pleural Instillation of Fibrin Glue and Autologous Blood to Manage Persistent Air Leaks after Lung Resection

Giorgio Maria Ferraroli; Gianluca Perroni; Veronica Maria Giudici; Alberto Antonicelli; Hiran Chrishantha Fernando; Vincenzo Ambrogi; Marco Alloisio; Emanuele Voulaz; Edoardo Bottoni; Maurizio Valentino Infante; Alberto Testori

doi:10.3390/jcm11071934

Bronchoscopic Intra-Pleural Instillation of Fibrin Glue and Autologous Blood to Manage Persistent Air Leaks after Lung Resection

J Clin Med. 2022 Mar 30;11(7):1934. doi: 10.3390/jcm11071934.

Authors

Affiliations

¹ Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, 20089 Milan, Italy.
² Department of Thoracic Surgery, Tor Vergata University, 00133 Rome, Italy.
³ Division of Thoracic Surgery, IRCCS San Raffaele Hospital, 20132 Milan, Italy.
⁴ Department of Cardiothoracic Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
⁵ Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy.
⁶ Department of Thoracic Surgery, University and Hospital Trust of Verona, 37126 Verona, Italy.

Abstract

Background: Persistent air leak is a common complication after lung resection causing prolonged length of stay and increased healthcare costs. Surgical intervention can be an option, but other more conservative approaches should be considered first. Here, we describe the use of flexible bronchoscopy to apply fibrin glue and autologous blood sequentially to the damaged lung. We named the technique "flexible thoracoscopy".

Methods: Medical records from patients with persistent air leaks after lung resection were collected retrospectively. Depending on the type of aerostasis that was performed, two groups were created: flexible thoracoscopy and surgery (thoracotomy). Flexible thoracoscopy was introduced at our institution in 2013. We entered the pleural space with a bronchoscope following the same surgical pathway that was used for tube thoracostomy. Perioperative characteristics and outcomes were analyzed using R software (ver. 3.4.4).

Results: From 1997 to 2021, a total of 23 patients required an intervention for persistent air leaks. Aerostasis was performed via flexible thoracoscopy in seventeen patients (69%) and via thoracotomy in six patients (31%). The median age was 70 years (22-82). Twenty patients were males (87%). There was no difference in age, sex distribution, BMI, comorbidities and FEV1%. An ASA score of 3 was more represented in the flexible thoracoscopy group; however, no evidence of a difference was found when compared to the thoracotomy group (p = 0.124). Length of in-hospital stay and chest tube duration was also similar between groups (p = 1 and p = 0.68, respectively).

Conclusions: Aerostasis achieved either by flexible thoracoscopy or by thoracotomy showed similar results. We believe that flexible thoracoscopy could be a valid alternative to facilitate minimally invasive treatments for persistent air leaks. Further studies are needed to confirm these results.

Keywords: blood patch; bronchoscopy; fibrin glue; flexible thoracoscopy; lung resection; persistent air leak; prolonged air leak; prolonged length of stay; thoracic surgery; thoracotomy.