Moreover, conversion to open thoracotomy should be not considered a failure of VATS, but rather a procedure for patient’s safety. Young surgeons at the beginning of their learning curve should perform VATS lobectomies under close supervision of a skilled VATS surgeon. The best strategy to face VATS complication is to prevent them. We have focused our attention on all the variables leading to conversion and conditioning the patient’s outcome in terms of post-operative complications and length of stay. Seventy-year older patients were not associated to a higher conversion rate, instead they showed an increased risk of post-operative complications (P<0,018, RR =1.8). This was significantly related to intraoperative bleeding and airway injuries (P<0,001). We performed a univariate and a multivariate analysis looking for the variables affecting the conversion rate. While conversion’s rate decreased from 33% in 2013 to 5.5% in 2015 and 10% in 2016.

The VATS lobectomies’ number increased over the three years: from 27 in 2013 to 55 in 2015 and 48 in 2016. Between January 2013 and December 2016, Udine Thoracic Department performed 180 video-assisted thoracoscopic surgery (VATS) lobectomies, and 24 cases were converted to thoracotomy due to an intra-operative complication such as arterial or venous bleeding, airway and other injuries. The object of our study is to show the causes leading to conversion, in order to observe the responsible variables and analyses if conversion influences the patient’s outcome.

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