Uniport vats versus biport vats in treatment of spontaneous pneumothorax

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 1 6 10.26663/cts.2022.001 156 article Uniport vats versus biport vats in treatment of spontaneous pneumothorax Mahmoud Sallam 1 Hussein Elkhayat 1 Ahmed Elminshawy 1 Department of Cardiothoracic Surgery, Assiut University, Faculty of Medicine, Assiut, Egypt Original Article CorrespondingBackground: To enhance postoperative outcomes in patients having video- assisted thoracic surgery (VATS) for spontaneous pneumothorax, it is necessary to determine the difference between the uses of each VATS treatment in such patients. Previous studies have revealed a discussion over the preference of one technique over the other. Materials and Methods: A comparative study was conducted on spontaneous pneumothorax patients (primary or secondary) undergoing VATS in Assiut University Heart Hospital from January 2017 till April 2019. Patients included in our study were prominent bullous forms in PSP pneumothorax lines, recurrent pneumothorax, bilateral pneumothorax, previous history of contralateral pneumothorax, and spontaneous hemothorax, air leakage more than five days with drainage catheter for first-episode patients. Patients were divided into two groups as group A patients who underwent uniport VATS procedure, and group B patients who underwent biport VATS procedure. Results: The study included 32 patients, 22 were primary spontaneous pneumothorax (PSP), while 10 were secondary spontaneous pneumothorax (SSP). The male to female ratio (MF ratio) was 3.2:1. The mean ± SD for age was 30.04 ± 10.245 in PSP and was 50.43 ± 9.071 in SSP. Eighteen patients underwent uniport VATS, and 14 underwent biport VATS. The mean time for operation was 81.5 ± 33.74 in uniport VATS versus 109.79 ± 25.37 in biport VATS (p = 0.014). No significant statistical difference was found between uniport and biport VATS regarding pain, air leak, complications, hospital stay, recurrence, and mortality. Despite no statistical difference regarding mortality (p = 0.492), there were two mortalities in the uniport VATS group known as interstitial pulmonary fibrosis. Conclusions: We concluded that there are no differences between both techniques except for operative time. https://cts.tgcd.org.tr/pdf.php?id=156 pneumothoraxvideo- assisted thoracic surgeryuniportmultiport eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 7 13 10.26663/cts.2022.002 157 article Do we need a small catheter drainage with chest tube after uniportal video-assisted thoracoscopic surgery for better drainage? Ali Abdelraouf 1 Hussein Elkhayat 1 Mohamed Osman 1 Ahmed Elminshawy 1 Department of Cardiothoracic Surgery, Assiut University, Faculty of Medicine, Assiut, EgyptBackground: Some of the residual effusion cannot be drained by the chest tube due to the high port position of the uniportal video-assisted thoracoscopic surgery (VATS) which theoretically leads to prolonged hospital stay. Hypothesis that putting an additional small catheter drain at the most depended part of the hemi-thorax together with chest tube after uniportal VATS to evaluate value of small catheter drainage with chest tube after uniportal VATS in hospital stay, pain score and chest x-ray. Materials and Methods: It represents a pilot prospective study randomized trial from August 2019 to August 2020 who had undergone uniportal VATS procedures were divided into two groups as group A (chest tube with small catheter) and group B (chest tube only). Results: Fifty-three patients underwent uniportal VATS only 30 where eligible to the study divided into two equal groups (18 males, 12 females). The mean age of patients in the small catheter with chest tube was 42.07 ± 12.85 years, compared to 34.93 ± 10.73 years in the chest tube only. Six different types of operation was done. Postoperative pain and hospital stays was nearly equal in both groups (p > 0.05). Postoperative residual effusion in immediate chest x-ray in small catheter with chest tube was managed by aspiration from small catheter and show improvement in follow up chest x-ray next morning (p < 0.05) but in chest tube only was management conservatively didn’t show improvement in follow up chest x-ray next morning (p > 0.05). Conclusions: Small catheter with chest tube didn’t add more pain. Although more than half of the cases get aspiration from small catheter and show improvement in follow up chest x-ray next morning, this does not statically affect hospital stay. https://cts.tgcd.org.tr/pdf.php?id=157 chest tubeuniportal VATSsmall catheter drainage eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 14 21 10.26663/ cts.2022.003 158 article Evaluation of the change in pain, dyspnea perception, and pulmonary function values with pain tape application in patients undergoing thoracotomy Sema Gül Türk 1 Hale Kefeli Çelik 2 Burçin Çelik 3 Zeynep Akça 4 Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, TurkeyClinics of Anesthesiology and Reanimation, Samsun Research and Education Hospital, Samsun, TurkeyDepartment of Thoracic Surgery, Ondokuz Mayıs University, Medical School, Samsun, TurkeyDepartment of Anatomy, Ondokuz Mayıs University, Medical School, Samsun, TurkeyBackground: We aimed to evaluate the changes in pain, dyspnea perception and respiratory functions by applying pain tape in the postoperative period in patients who underwent thoracotomy. Materials and Methods: 55 patients were included in the prospective, randomized study with local ethics committee approval. The patients were divided into two groups, and on the postoperative 1st day, pain tape was applied to group I patient and placebo tape similar to pain tape was applied to group II patient. Visual Analogue Scale (VAS) was used for pain assessment, Modified Borg Scale (MBS) for dyspnea assessment, pulmonary function test and six-minute walking test (6 MWT) were used to evaluate pulmonary functions in the preoperative and postoperative periods. Results: There were 29 patients in group I and 26 patients in group II, with mean age of 59.2 ± 10.4 (18- 75) years. According to the statistical analysis, no difference was found between the groups in terms of age, gender, height, weight, BMI, 6 MWT, MBS, FEV1, FVC, FEV1/FVC values (p > 0.05). There was a difference between the groups in terms of VAS values measured on the 3rd postoperative day (4.65 ± 1.79 vs. 6.57 ± 1.74; p > 0.001). In addition, the postoperative complication rate was different in group I compared to group II (17.2% vs. 30.7%; p = 0.003). Conclusion: Pain tape application is a reliable and simple method for pain control in the postoperative period in patients undergoing thoracotomy. It can be applied to patients for pain control in the early period, and in this way, the development of postoperative complications can be prevented. https://cts.tgcd.org.tr/pdf.php?id=158 paindyspneapain tapecomplicationthoracotomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 22 26 10.26663/cts.2022.004 159 article What covid-19 brings with: incidental solitary pulmonary nodules Mehmet Çetin 1 Hasan Tartar 1 Department of Thoracic Surgery, Omer Halisdemir University Training and Research Hospital, Niğde, TurkeyBackground: Thoracic computed tomography (CT) scans for preliminary diagnosis of COVID-19 can be used as a tool to detect solitary pulmonary nodules (SPNs). Materials and Methods: We retrospectively evaluated the thoracic CT reports of 5416 patients, aged 45-75, who presented to our hospital with a preliminary diagnosis of COVID-19 in 2020. Results: Pulmonary nodules/masses were detected in 85 patients. 56 of these were male, and 29 female. 63 patients (74%) had SPNs, 11 (13%) masses, and 11 (13%) multiple nodules. 5 patients were in follow-up for malignancy, and 21 (21%) arrived for follow-up after the detection of nodule/mass. 11 patients died due to pulmonary pathologies. Conclusions: COVID-19-related concerns have seriously disrupted the follow-up of pulmonary nodules. However, the widespread use of CT serves as a kind of lung cancer screening. https://cts.tgcd.org.tr/pdf.php?id=159 COVIDCO-RADSsolitary pulmonary nodulesincidental eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 27 34 10.26663/cts.2022.005 160 article The role of video-thoracoscopic sympathectomy in buerger and raynaud Uğur Temel 1 Department of Thoracic Surgery, University of Health Sciences, İstanbul Şişli Etfal Training and Research Hospital, TurkeyBackground: Buerger and Raynaud diseases are peripheral circulatory disorders that cause ulcers at fingers and affect the quality of life. The aim of this study is to detect the role of sympathectomy via video-assisted thoracoscopic surgery (VATS) in Buerger and Raynaud for an effective treatment. Materials and Methods: Study was designed retrospectively on prospective data. Sympathectomy via VATS, was applied to 45 patients who were diagnosed as Buerger or Raynaud disease in a 6-years period. Patients were followed with 6 months intervals. Age, gender, initial symptoms, smoking habit, quality of life with the operation type, duration and hospital stay were recorded. After surgery all datas related to the patient were also noted at follow-up period. Results: Ten of 45 patients were in Buerger disease group and 35 in Raynaud. After VATS, existing finger ulcers were regressed 100% and regression in symptoms was more than 70% for both diseases. For overall, progression in life quality was noted as more than 95% of patients. Median hospital-stay was 2 days. There was no mortality and serious complication. Pneumothorax was the most common complication. Conclusions: In order to increase the life quality of the patients and prevent the tissue loss, sympathectomy seems the only satisfactory surgical method of treatment for Buerger and Raynaud diseases especially for the circularity disorders of upper extremities. https://cts.tgcd.org.tr/pdf.php?id=160 RaynaudBuergerulcerationsthoracoscopic sympathectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 35 41 10.26663/cts.2022.006 161 article Factors affecting survival after resection of stage iib non-small cell lung cancer Cemal Aker 1 Celal Bugra Sezen 1 Mustafa Vedat Doğru 1 Nisa Yıldız 1 Volkan Erdoğu 1 Levent Cansever 1 Muzaffer Metin 1 Mehmet Ali Bedirhan 1 Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyBackground: Our aim in this study was to evaluate prognostic factors affecting survival and diseasefree survival (DFS) in the subgroups of stage IIB NSCLCs. Materials and Methods: Patients with stage IIB NSCLC who underwent surgery in our hospital between January 2006 and December 2015 were included in the study. The patients were evaluated in two groups: T3N0 patients staged as IIB due to pN0 (Group A) and T1N1/T2N1 patients (Group B). Results: Of the 192 patients were included in the study. There were 47 patients in group A (24.5%) and 145 patients in group B (75.5%). 5-year survival rates was 58.2%. There was no statistically significant difference in survival according to T stage. The 5-year survival rates in the T1, T2, and T3 groups were 69%, 55.3%, and 54.6%, respectively (p = 0.34). The main prognostic factors affecting survival were advanced age (p = 0.02). The mean DFS was 72 months and the 5-year DFS rate was 54%. Advanced age and male sex, were identified as poor prognostic factors for DFS (p < 0.005). Conclusions: The stage IIB category remains heterogeneous despite the updated eighth edition IASCL staging system. The results of our study indicate that age was the main prognostic factors affecting survival in stage IIB NSCLC. However, the effect of visceral pleural invasion and lymph node involvement on survival in stage IIB subgroups was not detected, more comprehensive multicenter studies are still needed. https://cts.tgcd.org.tr/pdf.php?id=161 lung cancerstage IIbsurvivalprognostic factorspleural invasion eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 42 50 10.26663/cts.2022.007 162 article The importance of n1 lymph node dissection in non-small cell lung cancer Talha Dogruyol 1 Volkan Baysungur 2 Sevinc Citak 3 Sinem Dogruyol 4 Aysun Misirlioglu 2 Serda Kanbur 2 Levent Alpay 2 Cagatay Tezel 2 Department of Thoracic Surgery, Manisa City Hospital, Manisa, TurkeyDepartment of Thoracic Surgery, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Burdur State Hospital, Burdur, TurkeyDepartment of Emergency Medicine, Merkezefendi State Hospital, Manisa, TurkeyBackground: Not all of the N1 lymph nodes are routinely dissected during surgical resection of nonsmall cell lung cancer (NSCLC). The aim of our study is to determine the risk factors for N1 lymph node metastasis in NSCLC with peroperative dissection. Materials and Methods: Patients who underwent lung resection in our hospital between September 2014 and April 2016 were retrospectively included in this study. Resected specimens were dissected in the operating room by the surgeon before being put into formaldehyde solution. Patients were divided into three groups: with a single positive N1 node (Group 1), with multiple positive N1 nodes (Group 2), and with single or multiple positive N1 nodes and incidentally positive N2 nodes (Group 3). Results: Fifty patients were included (46 males, 4 females). Univariate analysis showed significant correlation between N1 positivity and left-sided tumor, left central mass, squamous cell carcinoma, maximum standardized uptake (SUVmax) on positron emission tomography (PET/CT), pneumonectomy, and tumor size (p < 0.05). Logistic regression showed that the risk of N1 involvement was higher for squamous cell carcinoma compared to adenocarcinoma in all three groups. Conclusions: Left central mass, squamous cell carcinoma, SUVmax ≥ 10, uptake in hilar lymph nodes on PET-CT, and tumor diameter > 3.5 cm correlated with single or multiple positive N1 nodes in our study. Specimen dissection in patients with such preoperative findings could improve the accuracy of pathological nodal staging, thus refining the assessment of prognosis and selection of patients who would benefit from adjuvant therapy. https://cts.tgcd.org.tr/pdf.php?id=162 lymph node dissectionlymphatic metastasisnon-small-cell lung carcinomasurgical pathologythoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 51 54 10.26663/cts.2022.008 163 article Surgeon powered robotic lobectomy: first case performed in turkey Celal Bugra Sezen 1 Muzaffer Metin 1 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, TurkeyIn this case report, the case of non-small cell lung cancer resection performed with surgeon-powered robotic surgery (sPRS) was evaluated in light of the literature. A 62-year-old male patient applied to our clinic with the complaint of non-specific chest pain. On the tomography of the patient, a mass of approximately 1 cm in the lower lobe of the right lung was detected, and there was no distant metastasis. A transthoracic needle biopsy was performed on the patient. Right lower lobectomy operation was performed using wristed instruments (Artisential® Wristed Instruments) in this non-small cell lung cancer patient. sPRS provides more mobility than VATS and we think that it is a more cost effective surgical instrument than robotic surgery. We think that surgeons should embrace new technologies in order to provide more benefits to patients. https://cts.tgcd.org.tr/pdf.php?id=163 Non-small cell lung cancerrobotic surgerysurgeon powered robotic surgerylobectomyVATS eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-03-31 7 1 55 58 10.26663/ cts.2022.009 164 article Parkinson and atraumatic sternum fracture: a case report Özlem Orhan 1 Funda Cansun 2 Department of Orthopedics and Traumatology, Harran University Faculty Of Medicine, Sanliurfa, TurkeyDepartment of Thoracic Surgery, Sanliurfa Research and Training Hospital, Sanliurfa, TurkeyAlthough sternum fractures are more common after direct and impact trauma, they are rarely caused by pathological reasons. Sternum insufficiency fractures have been reported rarely in elderly patients. In the literature, sternum fracture after low-energy indirect trauma has been rarely reported. Our aim in this case is to present a 79-year-old female patient with chest pain after indirect trauma and a sternum fracture on admission to the emergency department. The patient with previously known Parkinson’s disease had a manubrium sternum fracture on computed tomography, and no additional pathology was found. https://cts.tgcd.org.tr/pdf.php?id=164 sternumatraumaticinsufficiency fractureParkinson’s disease