Feasibility of uniportal vats in the histopathological diagnosis of the peripheral pulmonary nodules which are marked by methylene blue before resection

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 68 73 10.26663/cts.2023.0011 196 article Feasibility of uniportal vats in the histopathological diagnosis of the peripheral pulmonary nodules which are marked by methylene blue before resection Volkan Karaçam 1 Fatma Mutlu 1 İlkay Kaya 1 Aytaç Gülcü 2 Kemal Can Tertemiz 3 Aydın Şanlı 1 Duygu Gürel 4 Department of Thoracic Surgery, Dokuz Eylul University Faculty of Medicine, İzmir, TurkeyDepartment of Radiology, Dokuz Eylul University Faculty of Medicine, İzmir, TurkeyDepartment of Chest Diseases, Dokuz Eylul University Faculty of Medicine, İzmir, TurkeyDepartment of Pathology, Dokuz Eylul University Faculty of Medicine, İzmir, TurkeyBackground: This study aims to reveal the diagnostic success to determine nodule localization, by marking the nodules with methylene blue, its contribution to operation time, and perioperative complications. Materials and Methods: In 52 patients with peripheral pulmonary nodules smaller than 20 mm, the nodule was marked by injecting 0.5-1 cc methylene blue with the guidance of computed tomography (CT) with a Chiba needle (22 G), before they were taken to the operating room. A frozen section examination was done after wedge resection with VATS. Results: The mean nodule size in the study was 8.85 mm (3-25 mm). The mean measurement distance to the chest wall at the peripheral endpoint of the nodules was 9.0 mm (1-40 mm). Of the nodules, 22 were solid, 15 were semisolid, and 15 were ground glass. Pathology subtypes were as follows, especially in ground glass lesions whose localization could not be determined without marking; 7 adenocarcinomas, 2 adenocarcinomas in situ, 4 atypical adenomatous hyperplasias, and 2 benign cytology. The pathologies for the other 37 patients resulted in 13 benign cytology, 10 metastases of known malignancy, 3 lung squamous cell carcinoma (pT1bN0, pT1aN1), 7 adenocarcinoma (pT1aN0- pT2N0), 1 adenocarcinoma in situ, 2 typical carcinoids (pT1aN0) and 1 atypical adenomatous hyperplasia. Conclusions: Through CT-guided percutaneous methylene blue marking, the localization of peripherally located, small-sized, and non-palpable lesions can be detected easily with uVATS. In this way, unnecessary thoracotomy can be avoided, the operation can be performed quickly and with low morbidity, and the diagnosis of lung cancer can be provided at an early stage. https://cts.tgcd.org.tr/pdf.php?id=196 videothoracoscopic surgerymethylene bluedyeground glass noduleuniportal eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 74 79 10.26663/cts.2023.0012 197 article Importance of simulation devices in thoracic surgery education: a prospective comparative study Celal Bugra Sezen 1 Gamze Tanrikulu 1 Mustafa Vedat Dogru 1 Semih Erduhan 1 Yasar Sonmezoglu 1 Volkan Erdogu 1 Nisa Yildiz 1 Ozkan Saydam 1 Muzaffer Metin 1 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyBackground: This manuscript aims to evaluate VATS lobectomy simulation training and the success of surgeons who have just started on simulation. Materials and Methods: In the study, which was designed prospectively, we used a VATS simulation device to evaluate two expert surgeons and three residents’ VATS right upper lobectomy outcomes. Fortyfive resections were performed by residents (Group-A), while 43 resections were performed by expert surgeons (Group-B). Results: 45 (51.1%) were in Group-A, and 43 were in Group-B 78 (88.6%) successful resections were completed in simulation. The division and stapling time of the bronchus, superior pulmonary vein, and superior pulmonary artery was shorter for Group-B than for Group-A (p < 0.05). Eight resections (17.8%) could not be completed in Group-A due to complications, while in Group-B, two resections (4.7%) were incomplete due to complications (p = 0.090). Conclusions: Based on this study, we believe that the experience of novice surgeons can be increased, especially with simulation training. Completion of similar operations also showed good content validity, especially when compared with experienced surgeons. https://cts.tgcd.org.tr/pdf.php?id=197 VATSstimulationthoracic surgerylobectomylung resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 80 84 10.26663/cts.2023.0013 198 article Is it a coincidence that covid-19 and pneumothorax coexist? Serkan Bayram 1 Mustafa Akyıl 1 Pelin Erdizci 1 Serda Kanbur Metin 1 Abidin Levent Alpay 1 Selami Volkan Baysungur 1 Department of Thoracic Surgery, University of Health Sciences, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, TurkeyBackground: We aimed to investigate the relationship between COVID-19 and pneumothorax by examining patients who developed pneumothorax during the treatment of COVID-19 infection, and patients who were diagnosed with COVID-19 infection during hospitalization procedures due to pneumothorax. Materials and Methods: We retrospectively analyzed patients who were hospitalized due to COVID-19 infection and developed pneumothorax, and patients who were hospitalized for pneumothorax with a positive COVID-19 test performed during hospitalization procedures, between May 2020 and January 2021. We recorded the demographic, clinical and radiological characteristics of the patients; treatment modalities, and response times to treatment. We investigated the relationship between COVID-19 infection and pneumothorax. Results: Of the 25 patients included in the study, 20 (80%) were male and 5 (20%) were female. The average age was 45 (17-77). Sixteen (64%) had thoracic computerized tomography findings consistent with COVID-19. Bilateral pneumothorax was observed in three (12%) patients. Pneumothorax was seen in 7 (28%) patients during mechanical ventilation. Tube thoracostomy with wet suction control closeddrainage system was applied to all patients. The average length of stay in the hospital was 7.8 (3-20) days. Recurrent pneumothorax developed in two (8%) patients after discharge, while the mortality rate was 12%. Conclusions: In patients with COVID-19 pneumonia, pneumothorax due to mechanical ventilation can develop, as well as pneumothorax can be observed even in asymptomatic COVID-19 cases. This condition needs immediate recognition and prompt treatment as a life-threatening event in COVID-19 patients. https://cts.tgcd.org.tr/pdf.php?id=198 COVID-19pneumothoraxSARS-CoV-2tube thoracostomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 85 90 10.26663/cts.2023.0014 199 article Analysis of non-operative management of 53 thoracic gunshot injuries in a training hospital from a thoracic surgical perspective Merve Sengul Inan 1 Hakan Isik 1 Ufuk Unsal 1 Ersin Sapmaz 1 Kuthan Kavakli 1 Hasan Caylak 1 Alper Gozubuyuk 1 Department of Thoracic Surgery, Gulhane Education and Training Hospital, Ankara, TurkeyBackground: Although clinicians use selective non-operative control of thoracic gunshot injuries (TGSI), parameters that may affect the clinical response have not been studied. The aim of this study is to determine the safety and clinical outcome of non-operative follow-up of TGSIs. Materials and Methods: Demographic, radiological and clinical features of 53 TSGIs, 2 female and 51 male, who were followed conservatively were examined. The data from the patients were retrospectively studied in terms of age, gender, extra-thoracic organ injuries, duration of chest tube, and length of hospital stay. Results: Median age was 24. Twenty patients had extrathoracic injury (%37.7). The presence of extrathoracic pathology did not affect the total length of stay, but the diameter of hemothorax, pneumothorax or contusion did. No correlation was observed between the length of stay of the chest tube and the Thoracic Trauma Severity Score (TTSS) or Injury Severity Score (ISS) of the patients (p = 0.756, p = 0.160). No correlation was observed between the diameter of the contusion area and the TTSS score or ISS score (p = 0.672, p = 0.201). Conclusions: Thoracic gunshot injuries can be approached conservatively by close monitoring and being aware of all life-threatening conditions. While trauma scores are quite adept at predicting length of stay, they do not always correlate with trauma severity. https://cts.tgcd.org.tr/pdf.php?id=199 gunshot woundschestpenetrating traumaselective nonoperative management eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 91 95 10.26663/cts.2023.0015 200 article Single center experience of war-related thoracic injuries in syria Ahmet Ulusan 1 Ibrahim Emre Tunca 1 Maruf Sanli 1 Ahmet Feridun Isik 1 Department of Thoracic Surgery, Gaziantep University, Gaziantep, TurkeyBackground: The Syrian civil war caused serious deaths and injuries. Thoracic surgery has shown its effectiveness in this war as it is a war surgery. In this study, we aimed to analyze and convey our experience with 47 war-related chest trauma patients to describe the chest trauma profile and determine the predictive morbidity and mortality. In this study, we aimed to analyze and convey our experience with 47 war-related chest trauma patients to describe the chest trauma profile and determine the predictive morbidity and mortality. Materials and Methods: From 2012 to 2017, 47 consecutive patients underwent surgical treatment for chest trauma at the Gaziantep University Hospital, in Turkey. The demographic and relevant clinical information was retrospectively collected from the hospital records. Data included mechanism of injury, gender, age, findings, treatment modality complications, length of hospital stay, morbidity, and mortality. Injuries were classified as penetrating (gunshot or shrapnel wounds) and blunt injuries. Results: The average age of patients was 25.4 years (range, 4 to 43 years) and 40 patients were males (85%). Sadly, 6 patients were under 18 years old. 41 patients (87.2%) with penetrating and 6 (12.8%) with blunt injuries. The most penetrating injuries to the chest were caused by shrapnel (61.7%). Eleven patients had already had emergency thoracotomy in another hospital before admission. In our study, 28 patients had pneumothorax, and 22 patients had hemothorax (Some patients have multiple diagnoses). However, there were 26 (23.64%) lung contusions in patients. No surgery-related deaths or major morbidity occurred. So, in all cases, the mortality rate was 2.13%. Conclusions: Intervention in thoracic trauma patients is lifesaving and satisfying compared to other system injuries. Most thoracic injuries can be treated with tube thoracostomy and conventional therapy. https://cts.tgcd.org.tr/pdf.php?id=200 warthoracic injurysurgerytraumapenetrating injuryblunt injury eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 96 99 10.26663/cts.2023.0016 201 article Analysis of erroneous appointments from the thoracic surgery outpatient clinic of a training hospital Ekin Zorlu 1 Önder Kavurmacı 1 Department of Thoracic Surgery, University of Health Sciences, Bozyaka Izmir Education and Research Hospital, Izmir, TurkeyBackground: Applications of patients to the outpatient clinics of health institutions are not subject to any control and are left to the patient’s choice. System is confused by patients, especially in close specialties, and patients make appointments from the outpatient clinic, which is unrelated to their complaints. Likewise, a group of patients does not come to arbitrary appointments. Making an erroneous appointment or failing to attend an appointment causes a serious loss of time for physicians and other patients. Appointments from an outpatient clinic not related to the disease. In our study, the data of patients who made an incorrect appointment from our outpatient clinic in the last one year and did not come to their appointment were analyzed retrospectively. Materials and Methods: The data of patients who made an incorrect appointment from our outpatient clinic and did not come to their appointments within a year using central physician appointment system were analyzed retrospectively. Results: Of 1482 patients who made an appointment through the central physician appointment system, 278 (18.8%) did not come to their appointment. 128 (8.6%) patients had an incorrect appointment. Conclusions: Organizing outpatient clinic appointments through the central system aims to enable patients to reach the service more easily and to benefit from the outpatient clinic service at a time convenient for them. It is a common situation that patients do not come to their appointments or make an incorrect appointment, causing unnecessary loss of workforce and the inability of other patients who request outpatient services to get an appointment. https://cts.tgcd.org.tr/pdf.php?id=201 thoracic surgeryoutpatient cliniccentral physician appointment systemerroneous appointments eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 100 105 10.26663/cts.2023.0017 202 article Abdominothoracic fistulas due to complicated echinococcosis: surgical treatment and outcome Yekta Altemur Karamustafaoglu 1 Fazlı Yanık 1 Yener Yoruk 1 Department of Thoracic Surgery, Trakya University, Faculty of Medicine, Edirne, TurkeyBackground: Abdominothoracic fistulas are severe complications of hydatid disease. We report here on the results of treatment of hydatid abdominothoracic fistulas in 17 patients. Material and Methods: A single-center case series of 17 patients with abdominothoracic fistulas (ATF) was treated at our hospital from 2004 and 2019. Nine men and eight women patients (age range: 46-85 years; median age: 59 years) were treated for abdominothoracic fistulas (ATF). The main symptoms were dyspnea, chest pain, cough, purulent sputum, high fever in 15 patients and additionally biliptysis in two patients. Fistulas were hepatopleural (HPF) in 14, bronchobiliary (BBF) in two and abdominopleural in one patient. Results: Fourteen patients were operated for HPF and 3 (18%) patients were treated with percutaneous transhepatic drainage and tube thoracostomy. All patients were discharged from the hospital in good health. Our strategy consisted of adequate evacuation of the intrahepatic cyst,closure of the fistula via thoracophrenotomy and long term drainage of the intrahepatic or subhepatic cyst space up to ceased biliary drainage. Conclusions: ATF due to hydatid cyst is uncommon. In rare cases ATF may be present at the abdominal,thoracic or diaphragmatic level. Thoracophrenotomy is the best surgical treatment for all three levels.In unstable patients only long-term percutaneous drainage should be applied. Medical treatment with Albendazole is indicated when dissemination is confirmed. Early diagnosis and management of septic associated complications are main goal. https://cts.tgcd.org.tr/pdf.php?id=202 abdominopleural fistulacomplicationcyst hydatid eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 106 108 10.26663/cts.2023.0018 203 article Esophageal perforation, aortic pseudoaneurysm and aorto-oesophageal fistula caused by ingestion of a chicken bone Cihan Ozgur 1 Yekta Altemur Karamustafaoglu 2 Nermin Tuncbilek 3 Department of Radiology, Faculty of Medicine, Namik Kemal University, Tekirdağ, TurkeyDepartment of Thoracic Surgery, Faculty of Medicine, Trakya University, Edirne, TurkeyDepartment of Radiology, Faculty of Medicine, Trakya University, Edirne, TurkeyEsophageal foreign bodies are an emergency entity. Rarely, it can cause fatal complications such as aorto-oesophageal fistula. In this study, the authors present a case of esophageal perforation, aortic pseudoaneurysm, and aorto-oesophageal fistula in an adult male patient after chicken bone ingestion, resulting in a poor outcome. An urgent and multidisciplinary approach is very critical in the diagnosis, treatment, and clinical management of aorto-oesophageal fistula. https://cts.tgcd.org.tr/pdf.php?id=203 aorto-oesophageal fistulaaortic pseudoaneurysmchicken boneesophageal perforationforeign body eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 109 112 10.26663/cts.2023.0019 204 article Six different types of primary tumors in a lady: multiple primary tumors Funda İncekara 1 İlteriş Türk 1 Funda Demirağ 2 Şevki Mustafa Demiröz 3 Göktürk Fındık 1 Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, TurkeyDepartment of Pathology, University of Health Sciences, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, TurkeyDepartment of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, TurkeyMultiple primary tumors are the ones that develop in the same patient at the same or different times. Each separate tumor should be proved to be malignant by histologic examination to rule out metastatic disease. A 59 year-old female patient was referred to our clinic for a newly diagnosed solitary pulmonary nodule. She is an uncommon case who has six primary tumors; a Kaposi’s sarcoma of extremity, an infiltrative ductal carcinoma of breast and four different types of lung neoplasms. https://cts.tgcd.org.tr/pdf.php?id=204 adenocarcinoma in-situcarcinoid tumorinfiltrative ductal carcinomaKaposi’s sarcoma eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-08-23 8 2 113 116 10.26663/cts.2023.0020 205 article A case of tracheal adenoid cystic carcinoma treated with carinal resection and adjuvant radiotheraphy Murat Erdogan 1 Omer Topaloglu 1 Sami Karapolat 1 Ali Akdogan 2 Celal Tekinbas 1 Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, TurkeyDepartment of Anesthesiology, Karadeniz Technical University Faculty of Medicine, Trabzon, TurkeyAdenoid cystic carcinoma originates from the glands in the tracheobronchial mucosa and its primary treatment is complete surgical resection. A 43-year-old male patient presented to our clinic with the complaints of cough, phlegm and haemoptysis continuing for the last 2 years. In his physical examination, a decrease in breath sounds was found in his left hemithorax during auscultation. As chest x-ray showed a left hilar enlargement, a thoracic computed tomography was taken which revealed a mass 17x21 mm in size extending from the lateral side of the lower left tracheal wall into the left main bronchus, considerably constricting the lumen. A biopsy was taken from the lesion during fiberoptic bronchoscopy and its histopathologic examination led to the diagnosis of Adenoid cystic carcinoma. The patient was operated under general anaesthesia using right posterolateral thoracotomy which involved carinal resection and anastomosis of the distal side of the trachea with the right main bronchus end-to-end, and of the right intermediary bronchus with the left main bronchus end-to-side. Since surgical margin positivity was found in histopathologic examination, he was prescribed adjuvant radiotherapy. The patient is still asymptomatic after a 2-year follow-up. Although negative surgical margins may not be achieved in locally advanced adenoid cystic carcinoma, resection of the tumor through complex surgical procedures with the addition of adjuvant radiotherapy enables long term survival. https://cts.tgcd.org.tr/pdf.php?id=205 adenoid cystic carcinomatracheasurgeryradiotherapy