Starting experience in robotic thoracic surgery

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 106 113 10.26663/cts.2019.00121 87 article Starting experience in robotic thoracic surgery Murat Akkuş 1 Department of Thoracic Surgery, Saglik Bilimleri University, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyBackground: The robotic assisted thoracoscopic surgery (RATS) spreads rapidly across the whole world. In this paper, the objective was to present the training experience on RATS in our clinic along with the literature. Materials and Methods: Sixty-three consecutive patients, who had undergone RATS between February 2014 and December 2018, were included in this retrospective non-randomized study. The training period was designed as three phases. Twelve patients with solid and cystic mass lesions in the mediastinum and chest wall were included in group Phase 1. The group Phase 2 consisted of 16 patients who had thymoma and benign pulmonary mass lesions, and 35 consecutive patients were enrolled into group Phase 3 group who had undergone lobectomy. Results: The patients in all groups were compared in respect of the preoperative, perioperative and postoperative results. The docking time was significantly shorter in Phase 3 patients compared to the groups Phase 1 and 2 (p < 0.05). In the lobectomy group (Phase 3), as the console time and operation time was significantly shorter after the 20th patient than the prior patients, first 20 patients were accepted as the learning curve (p < 0.05). In the lobectomy group, in three patients the operation was converted to open surgery during the perioperative period (4.7%). No mortality was observed during the 30-day follow-up. One patient died in the 6th month of the long-term follow-up. The mean follow-up duration was 28.4 months. Conclusions: RATS is a safe, feasible, and minimally invasive method, which has low complication rates with a satisfying and short learning curve. https://cts.tgcd.org.tr/pdf.php?id=87 robot-assisted thoracoscopic surgeryrobotic lobectomyminimally invasive thoracic surgeryrobotic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 114 119 10.26663/cts.2019.00122 88 article Evaluation of the effect of video-assisted thoracoscopic surgery on early postoperative pain and quality of life Levent Cansever 1 Celal Bugra Sezen 1 Mehmet Ali Bedirhan 1 Department of Thoracic Surgery, University of Health Sciences, Yedikule Chest Diseases and Thoracic Surgery Health Application and Research Center, Istanbul, TurkeyBackground: Video-assisted thoracoscopic surgery (VATS) is more advantageous than open surgery. In particular, VATS is superior in terms of pain, physical functioning, and overall patient satisfaction. The aim of this study was to evaluate factors affecting early postoperative pain and quality of life in patients who underwent VATS for benign or malignant disease. Materials and Methods: Seventy-seven patients who underwent VATS in our hospital between March 1 and June 30, 2018 were evaluated retrospectively. Postoperative pain was assessed at 2, 6, and 24 hours postoperatively using Visual Analogue Scale (VAS). The short-form 36 (SF-36) quality of life questionnaire was used to assess early quality of life. Results: Of the 74 patients in the study, 50 were male (67.6%) and 24 were female (32.4%). Mean VAS score was 6.84 ± 1.63 at postoperative hour 2, 4.19 ± 1.36 at postoperative hour 6, and 2.58 ± 1.20 at postoperative day 1. Geriatric patients had significantly higher VAS pain scores at postoperative hour 6 and day 1 (p = 0.011, p = 0.013). Patients with benign disease had significantly higher quality of life compared to patients with malignancy (p < 0.001). The presence of complications and advanced age were associated with lower postoperative quality of life. Conclusions: Although VATS patients have less severe pain and better quality of life in the early postoperative period, patients with malignancy had worse physical, psychological, and emotional state. In addition, geriatric patients and patients with early postoperative complications showed larger decreases in early postoperative quality of life. https://cts.tgcd.org.tr/pdf.php?id=88 quality of lifevideo-assisted thoracoscopic surgerytumorlung cancertreatment eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 120 125 10.26663/cts.2019.00123 89 article Sustained preservation of pulmonary function after pleurectomy/ decortication: should it be the main reason to perform surgery in malignant pleural mesothelioma patients? Simge Ozer 1 Serdar Ince 1 Tugce Sevval Koyi 1 Aslihan Cikmazkara 1 Sevim Gulsen Ozeren 1 Zeynep Bilgi 2 Hasan Fevzi Batirel 1 Department of Thoracic Surgery, Marmara University, School of Medicine, Istanbul, TurkeyDepartment of Thoracic Surgery, Medeniyet University, School of Medicine, Istanbul, TurkeyBackground: Pleurectomy/decortication for malignant pleural mesothelioma is performed to improve survival and pulmonary function. Our aim was to analyze pulmonary function outcomes following pleurectomy/decortication. Materials and Methods: 95 patients underwent pleurectomy/decortication for mesothelioma between years 2005-2016. 30 patients were alive at the time of analysis. Three patients were not fit to perform spirometry and three patients were living in rural areas. In 24 patients, spirometry was performed and compared with preoperative values. Demographic data, side, surgical technique, histology, recurrence, FEV1 (% and L), FVC (% and L), change in FEV1 and FVC were recorded and analyzed. A control group (n = 9) was formed with lung cancer patients who underwent lower lobectomy. Results: Average age was 56 ± 10 years (26-75). 13 extended and 11 partial pleurectomy/decortications were performed. Average hospital stay was 6.9 ± 3.4 days. 21 patients had epithelioid and 13 had T3-4 tumors. 23 patients had adjuvant chemotherapy, while 7 had adjuvant high dose radiation. Median survival was 31 months (6.4 - 83). Average preoperative and recent FEV1 (L) were 2.18 ± 0.82 and 1.84 ± 0.61 respectively (p = 0.004). The values were slightly higher for lower lobectomy patients. Average percentage change in FEV1 was -11.5 ± 23 which was very similar with control group (-12.4 ± 15). In 6 MPM patients, recent FEV1 (L) was higher than preoperative. Conclusions: Pleurectomy/decortication results in stable or improved pulmonary function in 40% of the patients independent of survival. The change in FEV1 is identical with lower lobectomy patients. Pleurectomy/decortication should be the preferred technique in resectable mesothelioma patients. https://cts.tgcd.org.tr/pdf.php?id=89 malignant pleural mesotheliomapulmonary functionpleurectomy/decortication eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 126 130 10.26663/cts.2019.00124 90 article The role of bronchoalveolar pattern of the former classification in the 8th edition of iaslc-tnm classification Demet Yaldız 1 Arkın Acar 2 Zekiye Aydoğdu 3 Şeyda Örs Kaya 2 Mehmet Sadık Yaldız 1 Department of Thoracic Surgery, Manisa Celal Bayar University, School of Medicine, Manisa, TurkeyDepartment of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training Hospital, İzmir, TurkeyDeparment of Pathology, Dr. Suat Seren Chest Diseases and Thoracic Surgery Training Hospital, İzmir, TurkeyBackground: Until the reclassification by the International Association for the Study of Lung Cancer, the term bronchoalveolar carcinoma (BAC) has been used for many years. Accordingly, the terms BAC and mixed adenocarcinoma were replaced by the terms such as adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic dominant type adenocarcinoma, mucinous minimally invasive adenocarcinoma, and mucinous invasive adenocarcinoma. The aim of this study was to retrospectively evaluate the cases diagnosed as BAC and mixed type adenocarcinoma operated in our clinic and to compare the clinical and survival characteristics of these cases according to the new classification. Materials and Methods: 37 patients who were operated in our clinic between January 2005 and December 2014 and diagnosed as BAC and mixed adenocarcinoma containing BAC components were included in the study. Pathologic slides were re-reviewed by the pathologists of our hospital and reclassified according to the predominant histologic subtype. In addition to the predominant cell type, the ratio of other cell types were also specified in 5% ratio slices. Results: The histopathological diagnoses of 37 formerly BAC patients, 14 of whom were mixed type, were changed as 33 lepidic, two mucinous, one adenocarcinoma in situ and one micro-invasive adenocarcinoma. The 5-year survival rate for lepidic predominant histological subtype was 70.3, while it was 50% (p = 0.533) for the two mucinous cases. Conclusions: The predominant cell type distribution used in the new classification of IASLC is more effective in determining survival and is more suitable for use in treatment and follow-up programs. https://cts.tgcd.org.tr/pdf.php?id=90 lung canceradenocarcinomabronchoalveolar carcinomaclassificationstaging eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 131 135 10.26663/cts.2019.00125 91 article Rediscovering the legendary treatment of prolonged air leak: therapeutic pneuomoperitoneum Şevki Mustafa Demiröz 1 Göktürk Fındık 1 İlteriş Türk 1 Koray Aydoğdu 1 Funda İncekara 1 Sadi Kaya 1 Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyBackground: Therapeutic pneumoperitoneum was first described for overcoming pulmonary tuberculosis in the end of 19th century. However, in time, another indication “prolonged air leak” (PAL) after major lung resections, lung volume reduction surgery and decortication operations have come on the scene and this legendary treatment have took place again. Despite the developing technology, medical devices and tools thoracic surgeons still sometimes need to use this treatment to cope with PAL. Materials and Methods: Twelve patients underwent pulmonary operations were included. Nine of the patients had PAL and three had massive air leak with subcutaneous emphysema in early postoperative period. On mean postoperative 8th day (1-15), a one session pneumoperitoneum was applied. In order to fulfill the vascular bed to prevent from air embolism, all of the patients received 500-1500cc of intravenous saline so that the venous pressure is between 7 and 12. Results: All 12 patients developed no sequel or chronic complications due to the intervention. Mean hospital stay after the intervention was 8.1 days (2-12), mean chest tube removal time after pneumoperitoneum was 16 days (2-48). Six of the patients were discharged with a complete success (without a chest tube), five patients were discharged with a Heimlich valve and one with passive drainage catheter, but the latter patients were also fully recovered in following days. Conclusions: In this report, we present 12 cases treated successfully with therapeutic pneumoperitoneum without any severe complications. The unique side of our technique is we used only single application without any need of extra instruments. https://cts.tgcd.org.tr/pdf.php?id=91 prolonged air leakpneumoperitoneumlung resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 136 139 10.26663/cts.2019.00126 92 article A rare cause of chest pain: pleuropulmonary solitary fibrous tumor Raúl Gonzalez Luna 1 Gerardo Rea Mendoza 1 Christian Ramirez Sanchez 1 Department of Thoracic Surgery, Organismo Público Descentralizado de Hospitales Civiles de Guadalajara, Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, MexicoA 45-year-old female patient is referred to our service for presenting seven months with left chest pain accompanied by dyspnea. At the chest tomography, a low-density mass with the presence of multiple vascularized septa, without evidence of tumor extension, without mediastinum nodes growth, neither metastatic lesions. The patient was operated with posterolateral thoracotomy. In the exploration, a 10x8x6 cm spherical mass was found which was solid, mobile, with pulmonary apical parenchyma peduncle, and it was totally excised. The postoperative pathology of the patient was reported as a pleuropulmonary solitary fibrous tumor. The management of this case took guidance from the Perrot’s recommendations, surgical resection is the mainstay treatment. https://cts.tgcd.org.tr/pdf.php?id=92 pleuropulmonary solitary fibrous tumorsolitary fibrous tumor of the pleurasurgical resectionstratification models eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 140 142 10.26663/cts.2019.00127 93 article The treatment of foreign body reaction and inflammation caused by prosthetic material with surgery and negative pressure wound therapy Yunus Aksoy 1 Necati Çıtak 2 Özgür İşgörücü 2 Çiğdem Obuz 1 Adnan Sayar 3 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Diseases and Thoracic Surgery Health Research and Application Center, Istanbul, TurkeyDepartment of Thoracic Surgery, Istanbul Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Memorial Bahçelievler Hospital, Istanbul, TurkeyForeign body reaction and deep wound infection (DWI) following sternal resection and reconstruction represent a serious problem. In recent years, negative pressure wound therapy (NPWT) have been used in clinical practice for treatment of DWIs. However, publications regarding the use of NPWT for the prosthetic material-related inflammation and DWI are yet quite rare. We present a very rare case, which is characterized with foreign body reaction and DWI after sternal reconstruction for a giant chondrosarcoma with the treatment of surgical debridement and NPWT. https://cts.tgcd.org.tr/pdf.php?id=93 chest wall reconstructionsternal wound infectionforeign body reactionsurgerynegative pressure wound therapy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 143 145 10.26663/cts.2019.00128 94 article Chest wall hydatid cyst: a case report Egemen Döner 1 Muammer Cumhur Sivrikoz 1 Erhan Durceylan 1 Department of Thoracic Surgery, Eskişehir Osmangazi University, Faculty of Medicine, Eskişehir, TurkeyHydatid cyst is a parasitic disease caused by Echinococcus cestode. Hydatid cyst is an important risk factor in rural areas especially in Mediterranean countries, Middle East and Australia. The disease is most common in the liver and then in the lungs and it is very rare to be seen primarily in the chest wall. We present a 31 years-old female patient with primary chest wall hydatid cyst and discuss the surgical treatment. https://cts.tgcd.org.tr/pdf.php?id=94 albendazolechest wallhydatid cyst eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 146 149 10.26663/cts.2019.00129 95 article Pneumoretroperitoneum, pneumomediastinum, pneumothorax and subcutaneous emphysema after diagnostic colonoscopy Önder Kavurmacı 1 Asuman Akın Türker 1 Bülent Alkan 2 Orhan Üreyen 3 Mehmet Tahsin Tekeli 3 Department of Thoracic Surgery, Bozyaka Training and Research Hospital, Izmir TurkeyDepartment of Gastroenterology, Bozyaka Training and Research Hospital, Izmir TurkeyDepartment of General Surgery, Bozyaka Training and Research Hospital, Izmir TurkeyColonoscopy is a safe procedure and in less than 1% of the patients, colonic perforation may be seen. Physical examination findings such as pain and distension of the abdomen are well-known symptoms however, dyspnea and tachypnea are seen in only a small number of cases as a sign of iatrogenic colon perforation. In this report, we present a 70-year-old female patient with iatrogenic pneumoperitoneum, pneumomediastinum, subcutaneous emphysema and bilateral pneumothorax after diagnostic colonoscopy. The patient was successfully treated with endoscopic colon repair and left tube thoracostomy. When atypical findings are present such as dyspnea and subcutaneous emphysema, iatrogenic pneumothorax, pneumomediastinum should be kept mind after colonoscopy. https://cts.tgcd.org.tr/pdf.php?id=95 colonoscopydyspneapneumothoraxpneumomediastinumsubcutaneous emphysema eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-12-31 4 3 150 152 10.26663/cts.2019.00130 96 article Novel surgical integration technique in ravitch procedure using an atraumatic o-ring wound retractor: case report Sergio Alberto Sanchez Vergara 1 Gerardo Rea Mendoza 1 Justo José Lopez Gimenez 1 Department of Thoracic Surgery, Organismo público descentralizado de hospitales civiles de Guadalajara, Hospital Civil Fray Antonio Alcalde, Guadalajara, Jalisco, MéxicoModified Ravitch procedure is the hallmark surgical procedure to repair pectus deformities, manual and auto self-retaining metal retractors are very helpful because they grant and maintain the surgical site exposure. However, these metal retractors often have sharp tips that are capable of causing soft tissue flaps damage. In abdominal surgery, using an atraumatic O-ring wound retractor has been associated with diminution of superficial surgical site complications and post-operative pain reduction due, these suggested benefits can be reproducible in modified Ravitch procedure. A 20-year-old male patient is referred to our service for presenting chest discomfort and body image issues. Subsequent work up revealed a pectus carinatum without associated congenital heart disease. A transverse infra-mammary skin 8 cm incision was made. We used an atraumatic O-ring wound retractor to expose surgical site and performed bilateral subperichondrial abnormal costal cartilages resection with sternum wedge osteotomy. Drains was removed in 24 hours, and the post-surgical hospital stay was 72 hours. In this case, using an atraumatic O-ring wound retractor improved exposure with shorter incision, facilitated stable access to the costal cartilage, protecting the skin from injury, and reduced the administration of intravenous analgesics. https://cts.tgcd.org.tr/pdf.php?id=96 modified Ravitch procedurepectusauto self-retractoratraumatic O-ring wound retractorsurgical retractor