Injury to intercostal nerves and vessels
This complication can be avoided either by dissecting strictly along the superior aspect of the rib or, as demonstrated in the present case, by bringing down the nerve at the inferior aspect of the rib under direct vision, since the intercostal vessels and nerves course along the inferior aspect. In case of any bleeding, secure the vessel with a suture ligature or a clip, since sealing by electrocautery alone is not reliable enough.
Rib fracture
If a rib fracture occurs, any sharp bone fragments must be removed with a Luer rongeur, as they could perforate the lung.
Bleeding when taking down pleural adhesions
→ Seal with electrocautery, haemostatics
Bleeding from a pulmonary vessel
→ selective coagulation or targeted clamping with a fine vascular clamp and suture ligature, otherwise the tear will be enlarged and the ligature will slip off; alternatively, tangential application of a Satinsky clamp and oversewing with atraumatic sutures.
Acute airway obstruction
→ intraoperative bronchoscopy
Cardiac disturbances
due to irritation of the vagus or phrenic nerve
Persistently leaking pulmonary parenchyma
resulting from tears during dissection → approximate the pleural margins with U-sutures