Minimally invasive approach to pleural empyema: uniportal or biportal?

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 59 65 10.26663/cts.2022.010 165 article Minimally invasive approach to pleural empyema: uniportal or biportal? Kerim Tuluce 1 Hasan Turut 1 Department Thoracic Surgery, Recep Tayyip Erdogan University, Training and Research, Rize, TurkeyBackground: Video-assisted thoracoscopic surgery (VATS) has become the standard treatment method for pleural empyema’s surgical treatment. Postoperative pain, length of hospital stay, and cosmetic results are satisfactory, especially with the uniportal approach. In this study, we retrospectively evaluated and compared outcomes of patients treated with uniportal and biportal VATS. Materials and Methods: A total of 73 patients who underwent VATS for empyema in our clinic between January 2017 and October 2020 were retrospectively evaluated. Patients who underwent uniportal and biportal VATS were compared in terms of age, sex, side and stage of empyema, length of hospital stay, comorbidities, smoking history, American Society of Anesthesiologists (ASA) physical status score, number of chest tubes placed postoperatively, postoperative Heimlich valve placement, postoperative complications, postoperative drainage volume, recurrence, preoperative and 72-h postoperative C-reactive protein (CRP) and white blood cell (WBC) values, and postoperative 24-h and 72-h VAS (visual analog scale) pain scores. Univariate comparisons were done with R-based Jamovi statistical software. Results: Fifty-two (71.2%) of the patients were male, and the mean age was 57 (IQR 41-67). Empyema was stage 2 in 38 (52.1%) patients and stage 3 in 35 (47.9%) patients. VATS was uniportal in 52 patients (71.2%) and biportal in 21 patients (28.8%). The uniportal VATS group had significantly lower drainage volume (p = 0.006) and VAS scores (p < 0.001). There were no statistical differences in the other parameters. Conclusions: Our data indicate that uniportal VATS was superior to biportal VATS for the treatment of empyema in terms of postoperative pain and drainage. https://cts.tgcd.org.tr/pdf.php?id=165 minimally invasive surgerythoracoscopyvideo-assisted thoracoscopic surgeryempyema eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 66 73 10.26663/cts.2022.011 166 article Conservative approach versus invasive approach for pneumothorax secondary to blunt trauma Özgür İşgörücü 1 Department of Thoracic Surgery, Yedikule Teaching Hospital for Chest Diseases and Thoracic Surgery, Istanbul, TurkeyBackground: The management of minimal pneumothorax, which has been detected more frequently with the increasing use of computed tomography, especially after blunt trauma, is controversial. This study aimed to examine the results of patients with pneumothorax secondary to blunt trauma and contribute to the treatment protocol for this group of patients. Materials and Methods: A retrospective analysis of patients with pneumothorax after blunt trauma (n = 103) presenting to the emergency department during the 1-year period from January 2019 to January 2020 was performed. Oxygen inhalation was performed in patients who were followed up conservatively, and tube thoracostomy was performed in patients who were treated invasively. Results: Among 766 patients with blunt trauma, 141 (18.4%) patients had a traumatic pneumothorax. Mechanical ventilation was required in 26.2% (n = 27) patients. Further, 73 (70.8%) patients with pneumothorax were followed up conservatively. The remaining 30 (29.1%) patients underwent tube thoracostomy. The median size of the pneumothorax (9 vs. 29 mm; p < 0.0001; hazard ratio [HR] = 5.08) was significantly different between the groups. Multivariate analyses revealed that positive pressure ventilation and pneumothorax size did not pose an additional risk of failure in conservative management (HR = 1.49; p = 0.25 and HR = 10.2; p = 0.09, respectively). Multivariate analyses revealed that the presence of hemothorax and subcutaneous emphysema (HR = 14.4; p = 0.018 and HR = 13.1; p = 0.019, respectively) led to failure of conservative treatment. Conclusions: The presence of hemothorax and subcutaneous emphysema was an independent factor leading to failure of conservative treatment. In the presence of these two findings indicating major trauma, invasive treatment is recommended. https://cts.tgcd.org.tr/pdf.php?id=166 traumapneumothoraxtube thoracostomysurgerymechanical ventilation eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 74 81 10.26663/cts.2022.012 167 article We need a common definition and treatment algorithm for displaced rib fracture Önder Kavurmacı 1 Sercan Aydın 2 Barış Gülmez 3 Seda Kahraman 4 Tevfik İlker Akçam 4 Ali Özdil 4 Ayşe Gül Ergönül 4 Onur Akçay 5 Banu Yoldaş 3 Asuman Akın Türker 6 Ekin Zorlu 1 Ali Karakılıç 7 Department of Thoracic Surgery, Health Sciences University, Izmir Bozyaka Training and Research Hospital, Izmir, TurkeyDepartment of Thoracic Surgery, Izmir Democracy University Buca Seyfi Demirsoy Education and Research Hospital, Izmir, TurkeyDepartment of Thoracic Surgery, Health Sciences University, Dr Suat Seren Chest Science and Chest Surgery Training and Research Hospital, Izmir, TurkeyDepartment of Thoracic Surgery, Ege University School of Medicine, Izmir, TurkeyDepartment of Thoracic Surgery, Bakırçay University, Çiğli Education Hospital, Izmir, TurkeyBodrum State Hospital, Muğla, TurkeyBalıkesir Atatürk City Hospital, Balıkesir, TurkeyBackground: Displaced rib fracture (DRF) definition is frequently used to draw attention to severity and importance of fracture in daily practice. DRF is associated with increased morbidity and mortality in addition patients with DRF should be followed more carefully. Despite these characteristics, we do not have a clear definition for DRF concept and big differences of opinion among physicians could be monitored. In this study, we tried to reveal these perceptual differences and emphasized the importance of creating a common language for DRF. Materials and Methods: We used a special and inventive survey form which contains visual section, true-false section and case reports. In the visual section, real tomography images and schematic drawings were presented to participants and asked which were compatible with DRF. In the true-false section, propositions about the definition of DRF were presented. Finally, imaginary trauma cases were presented and the minimum follow-up period was questioned. Results: 156 physicians from 23 different center were included in the study. Of the participants, 56 (35.9%) were emergency physicians, 54 (34.6%) were thoracic surgeons and 46 (29.5%) were radiologists. The answers were statistically different for 3 tomography image (p = 0.056, p < 0.001, p = 0.001) and for 1 schematic drawings (p = 0.001). Again in 4 of the 7 true-false questions, there were significant differences between answers (p = 0.001, p = 0.001, p = 0.005, p < 0.001). The minimum follow-up period for a patient with DRF was also different between physicians, and have been recommended as 15.9 ± 2.2 (2-72 hours) by emergency physicians, 27.3 ± 5.5 (2-120) by radiologist and 31.5 ± 3.1 (2-120) by thoracic surgeons. Conclusions: Our study clearly demonstrates a big conflict about DRF defination and treatment among physicians. There is also no consensus on the minimum follow-up time. We believe that our study will be a guide for multidisciplinary clinical studies on this subject. https://cts.tgcd.org.tr/pdf.php?id=167 fracturesinjuriesradiologyribsquestionnairesemergencies eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 82 86 10.26663/cts.2022.013 168 article Elastofibroma dorsi prevalance in patients with primary complaint of dorsalgia Zeynep Nilüfer Tekin 1 Zeynep Bilgi 2 Onur Akçay 3 Funda Cansun 4 Esen Kasapoğlu 5 Department of Radiology, Istanbul Medeniyet University Göztepe Prof Dr Süleyman Yalçın City Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Istanbul Medeniyet University Faculty of Medicine, Istanbul, TurkeyDepartment of Thoracic Surgery, Bakırçay University Ciğli Training and Research Hospital, Izmir, TurkeyDepartment of Thoracic Surgery, Şanlıurfa Training and Research Hospital, Şanlıurfa, TurkeyDepartment of Internal Medicine, Division of Rheumatology, Istanbul Medeniyet University Faculty of Medicine, Istanbul, TurkeyBackground: The aim of this study is to evaluate the prevalence of elastofibroma dorsi (EFD) in computed tomography (CT) imaging of the thorax in patients with dorsalgia. Materials and Methods: Patients who are greater than or equal to 50 years old and presented to our institution with chief complaint of dorsalgia and received a thoracic CT were identified and recorded in a database together with demographic information. Control group was chosen from consecutive trauma patients in the same age group and presented to emergency room and received thoracic CT as standard of care. Results: Out of 83 patients with common complaint dorsalgia, 9 (9/83, 10.8%) patients had no lesions and EFD was observed in 74 of the patients (74/83, 89.2%). 140 EFD including 106 (106/140, 75.7%) with a subscapular localization and 34 (34/140, 24.3%) with an infrascapular extension were identified. The maximum diameter average was 4.1 cm (range = 1-11.5 cm). Unilateral lesion was detected in 8 (8/74, 10.8%) and bilateral lesions was observed in 66 (66/74, 89.2%) of the patients. Detection of EFD in patients with isolated dorsalgia complaints was significantly higher than patients with multiple complaints (78.4% vs 21.6%, p = 0.009). Conclusions: Middle aged and elderly patients with isolated dorsalgia show an unusually high EFD prevalence. Clinical suspicion and diagnostic work-up can help those cases for timely diagnosis and treatment. https://cts.tgcd.org.tr/pdf.php?id=168 Elastofibroma dorsithorax CTdorsalgiaprevalence eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 87 91 10.26663/cts.2022.014 169 article An analysis of cigarette smoking in thoracic surgery patients Yunus Seyrek 1 Onur Volkan Yaran 1 Merve Özbek 1 Nilüfer Menekşe 1 Levent Cansever 1 Mehmet Ali Bedirhan 1 Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Disease and Thoracic Surgery Application and Research Center, Istanbul, TurkeyBackground: Cigarette smoke (CS) is a long-term risk factor for several disorders of the respiratory and cardiovascular systems. In this study, we aimed to analyze the current effects of cigarette smoke on patients who underwent thoracic surgery. In line with this purpose, we analyzed patients who were admitted to a thoracic surgery clinic recently and their smoking history. Materials and Methods: We reviewed patients who underwent thoracic surgery (n = 867) and were admitted to our clinic between January 2018 and December 2018. The patients were categorized into seven groups comprising the most common types of thoracic pathology as, lung carcinoma (n = 338), pneumothorax (n = 219), pleural effusion (n = 131), mediastinal lymphadenopathy (n = 77), pneumomediastinum (n = 22), bronchiectasis (n = 30), and hydatid cyst (n = 10). Cases were reviewed in detail for demographics, smoking history in terms of pack-years, thoracic pathology, and hospitalization duration (days). Results: Statistical analysis revealed that smoking is still a significant factor contributing to lung cancer. Cigarette smoke did not appear to be a factor in mediastinal lymphadenopathy, bronchiectasis, pleural effusion or hydatid cyst cases. Additionally, hospitalization duration was significantly longer in the smoker group. Conclusions: The data reviewed are compatible with the current knowledge on the mechanisms of cigarette smoke-related pathologies. Cigarette smoke is still associated with common thoracic surgery pathologies such as lung carcinoma, pneumothorax, and pneumomediastinum. This may be rephrased thus, the absence of cigarette smoke would greatly decrease the prevalence of thoracic surgery cases. https://cts.tgcd.org.tr/pdf.php?id=169 cigarette smokinglung neoplasmspneumothoraxpleural effusionlymphadenopathymediastinumCOPDthoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 92 96 10.26663/cts.2022.015 170 article Giant pediatric intrathoracic ganglioneuroma: a case report and review of the literature Buse Mine Konuk Balcı 1 Gökhan Kocaman 1 Mehmet Ali Sakallı 2 Bülent Mustafa Yenigün 1 Ayşegül Gürsoy Çoruh 3 Bilge Ayça Kırmızı 4 Aylin Heper 4 Serkan Enön 1 Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ankara TurkeyDepartment of Thoracic Surgery, Iskenderun State Hospital, Hatay, TurkeyDepartment of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey4Department of Radiology, Ankara University Faculty of Medicine, Ankara, TurkeyGanglioneuroma is an extremely rare (incidence 1/1,000,000) well-differentiated neurogenic tumor that mostly originates from neural crest cells. The average age of diagnosis is 7 years old and it is mostly located in the posterior mediastinum (37.5%). Here we present a 10-year-old girl with a giant thoracic ganglioneuroma. The tumor was resected via posterolateral thoracotomy. With our case report included, there are 10 cases of surgically treated pediatric giant intrathoracic ganglioneuroma. https://cts.tgcd.org.tr/pdf.php?id=170 giantganglioneuromapediatricthoracic surgeryposterior mediastinal tumors eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 97 100 10.26663/cts.2022.016 171 article The surgical repair of a trauma-related sternoclavicular joint dislocation using the musculus gracilis tendon Sule Karadayi 1 Fatmagul Demir 1 Seyran Kılınç 2 Department of Thoracic Surgery, Cumhuriyet University School of Medicine, Sivas, TurkeyDepartment of Orthopedics, Cumhuriyet University School of Medicine, Sivas, TurkeySternoclavicular joint (SCJ) dislocations are rare, and these dislocations may be traumatic or atraumatic. In this study, we will examine the treatment management of a patient whose SCJ was anteriorly dislocated following a traffic accident. We performed open stabilization for SCJ dislocation using the musculus gracilis tendon. Although the first treatment option in acute cases is closed reduction and stabilization, we recommend surgical repair because the probability of recurrence is high. The gracilis tendon is a good option for joint stabilization. https://cts.tgcd.org.tr/pdf.php?id=171 sternoclavicular jointtraumaaccidentsinjuriesjointssurgical procedures eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 101 104 10.26663/cts.2022.017 172 article A rare cause of acute airway obstruction: tracheal malignant melanoma Omer Faruk Demir 1 Omer Onal 1 Burcu Baran 2 Alperen Vural 3 Oguzhan Turan 1 Department of Thoracic Surgery, Erciyes University, Faculty of Medicine, Kayseri, TurkeyDepartment of Respiratory Medicine, Erciyes University, Faculty of Medicine, Kayseri, TurkeyDepartment of Otorhinolaryngology, Erciyes University, Faculty of Medicine, Kayseri, TurkeyTracheal tumors are quite rare, with an incidence of 2.6 per 1,000,000 persons. Tracheal malignant melanomas are one of the least common types among these tumors due to the lack of natural epithelial tissue of melanocytes. There is no optimal treatment method for tracheal malign melanomas because they have an aggressive nature, have limited life expectancy and occur very rarely. This paper discusses the case of and treatment methods fora patient who was initially suspected to have a foreign body aspiration because of presenting to hospital with acute airway obstruction. https://cts.tgcd.org.tr/pdf.php?id=172 airway obstructiontracheal malign melanomatracheal tumor eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-07-29 7 2 105 108 10.26663/cts.2022.018 173 article Surgical treatment of an intrathoracic rib causing cough in a young woman Denizhan Kılınç 1 Merve Sengul Inan 1 Ersin Sapmaz 1 Hakan Işık 1 Sedat Gürkök 2 Department of Thoracic Surgery, Gulhane Education and Training Hospital, Ankara, TurkeyThoracic Surgery Clinic, Memorial Hospital, Ankara, TurkeyIntrathoracic rib is mostly asymptomatic and one of the rare congenital anomalies of thoracic wall. Keeping in mind its appearance and types on chest x-rays can prevent unnecessary examinations and invasive procedures. Locations and relationship to adjacent tissues of intrathoracic ribs determine its clinical course and surgical decision. https://cts.tgcd.org.tr/pdf.php?id=173 accessory ribanatomical variationsintrathoracic ribrib anomaliessupernumerary rib