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Lung or lobar torsion is a very rare condition that can cause serious complications if missed or untreated. We report a case of a 72-year-old man undergoing video-assisted thoracoscopic upper bilobectomy for treatment of lung cancer. On the first postoperative day radiographic and bronchoscopic findings suggested lobar torsion and then exploratory thoracotomy was carried out within 24 hours of the initial procedure performing simple detorsion and not completion pneumonectomy for various reasons: absence of pulmonary necrosis, incomplete rotation of the bronchovascular pedicle, patient’s inability to functionally tolerate a pneumonectomy. Unfortunately the patient didn’t show clinical and radiological improvement, during the postoperative period, and he died 12 days later due to cardiorespiratory complications. This case report highlights the need for prompt intervention in patients with lobar torsion within a few hours from the onset of the phenomenon. At the same time it highlights the possibility of fatal outcome in patients unable to functionally tolerate further lung resection. To the best of our knowledge, this is the first report of lobar torsion following video-assisted thoracoscopic upper bilobectomy.

Several authors have reported major complications during thoracoscopic pulmonary lobectomy but a few papers have been published concerning minor adverse events. This definition in our report takes into account no life-threatening intraoperative complications managed with minimal invasive approach and with no need for conversion to thoracotomy. We retrospectively reviewed 644 patients who underwent thoracoscopic anatomic pulmonary lobectomy between April 2011 and May 2018: among these, 25 patients suffered minor intraoperative complications such as bronchial injury, stapler failure during parenchymal resection, injury to bronchial artery, oozing from vascular stump, etc. Our findings suggest that these complications don’t adversely affect the early postoperative outcomes but they still need proper management to avoid major intraoperative complications and an eventful postoperative course. The report shows that minor adverse events may occur for device malfunction but, in some instances, human errors or inadequate knowledge of technological instruments may be implicated.