A Case of Massive Air Leakage After Lung Cancer Surgery Successfully Treated With the "Tachosuture" Technique and Intensive Management Under One-Lung Ventilation

Massive air leakage after lung resection can be difficult to control, especially in patients with vulnerable lung tissues due to underlying diseases. TachoSil® (Corza Medical, Linz, Austria) patch is applied to the site of air leakage during surgery to control air leakage; however, in cases of massive air leakage, it may peel off before the tissue has healed. This report describes a method for securely positioning the TachoSil® patch at the site of air leakage to control massive air leakage after lung resection. The patient was a 50-year-old man with a history of heavy smoking and alcoholic liver disease. He underwent a thoracoscopic resection of the left lower lobe and mediastinal lymph node dissection for the adenocarcinoma of the lower lobe of the left lung, cT1cN0M0 stage IA3, which was detected during a health checkup. Postoperatively, in the intensive care unit (ICU), the patient developed massive air leakage with uncontrolled subcutaneous emphysema expansion triggered by coughing. Therefore, a second surgery was performed on the same day, revealing that a pneumatocele had developed, which was causing air leakage. First, a TachoSil® patch was applied over the pleural defect, and stitches were added over it. Next, the normal pleura at both ends of the pneumatocele was sutured to sew it inside. Finally, an additional layer of TachoSil® patch was applied over it. The patient was then managed in the ICU under analgesia and sedation for three days with one-lung ventilation (OLV) of the right lung to avoid pressure loading on the left lung, and the tracheal tube was removed after confirming that air leakage had been managed. However, due to another massive air leak, we performed the same surgery again. As with the second postoperative period, the patient was managed for three days under OLV of the right lung; however, to ensure more stable management, we administered muscle relaxants in addition to analgesics and sedatives. After confirming that air leakage had been managed, the tracheal tube was removed, and there were no recurrences. In this case, the TachoSil® patch was sutured in place to stabilize it at the site of air leakage until the pleural mesothelium grows on the surface of the TachoSil® patch. This technique, in combination with management under OLV to reduce pressure loading on the affected lung, is expected to ensure the development of the pleural mesothelium. In this patient, the combination of the suturing TachoSil® patch in place at the site of air leakage during surgery and temporary postoperative OLV was associated with the successful control of massive air leakage from vulnerable lung tissue.