Benefits of routine uniportal thoracoscopy during rib fixation in the diagnosis and repair of diaphragmatic injury

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 1 5 10.26663/cts.2024.001 215 article Benefits of routine uniportal thoracoscopy during rib fixation in the diagnosis and repair of diaphragmatic injury Onur Derdiyok 1 Uğur Temel 1 Department of Thoracic Surgery, SBÜ Şişli Hamidiye Etfal Research and Training Hospital, Istanbul, TurkeyBackground: The incidence of missed diagnosis of traumatic diaphragmatic injury (TDI) is about 30%. Lower rib fractures may cause TDI. We aimed to present our clinical results of uniportal video-assisted thoracoscopic surgery (VATS) in terms of detecting and repairing TDI, in patients undergoing rib fixation. Materials and Methods: In this retrospective study, routine uniportal VATS was performed in patients planned to undergo rib fixation due to flail chest and severely displaced rib fractures between January 2021 and January 2023. The results of 11 patients with TDI were investigated. Results: All patients were male. Eighty-two percent of the patients had blunt type of injury. Most TDIs were detected during VATS (55%). There were 7 left and 4 right TDIs with diaphragmatic defects varying from 2 to 5 cm in size. Two patients had minor omental herniation. Mean number of fractured ribs was 4. Mean duration of operation was 139 minutes. Mean hospital stay was 7 days. Morbidity developed in 1 patient (9%, wound infection). Conclusions: Routine VATS in patients undergoing SSRF helps detecting and repair TDIs. Its diagnostic benefit in the diagnosis of acute TDI is greatest in patients with multiple rib fractures involving the lower chest wall, although there are no radiographic evidences of TDI. https://cts.tgcd.org.tr/pdf.php?id=215 diaphragm injuryuniportal thoracoscopyrib fracturetrauma eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 6 12 10.26663/cts.2024.002 216 article Vats versus open thoracotomy in patients with spontaneous pneumothorax: where do we stand? Nexhati Jakupi 1 Risto Colanceski 1 Ljubica Atanasova 1 Despot Despotovski 1 Department of Thoracic Surgery, University Clinic Mother Theresa, Skopje, Macedonia, the Former Yugoslav Republic ofBackground: Spontaneous pneumothorax (SP) can be surgically treated with video-assisted thoracoscopic surgery (VATS) or conventional open thoracotomy (OT), but there are still controversies in the literature concerning the outcome of both procedures. We aim to compare VATS and OT in the treatment of SP, in perioperative and postoperative outcome, as well as to determine which procedure is more cost-effective for both the patients and the health care system. Materials and Methods: Overall, 136 patients underwent surgery for SP at our institution, out of which 104 met the inclusion criteria of our study. Patients were further divided into two groups, consisting of 56 and 48 patients who underwent VATS and OT, respectively. Data were collected prospectively for 5 years and comparison of the perioperative and postoperative outcome, as well as cost-effectiveness of both procedures was performed. Results: The VATS group was superior to the OT with shorter duration of surgery (87.77 vs 132.92 min.; p < 0.05), reduced length of hospital stay (7.28 vs 9.81 days; p < 0.05) and chest drain duration (4.84 vs 5.98 days; p < 0.05). There was no statistically significant difference in the recurrence rate, bleeding and postoperative complications. Average cost per patient for VATS was significantly lower than the cost for open thoracotomy (EUR 1504.93 vs EUR 1973.09; p < 0.05). Conclusions: VATS can be implemented as the optimal approach in the treatment of SP given the current clinical, financial and cosmetic advantages. Like other minimally-invasive procedures, VATS has an associated learning curve which, once is surpassed, any complications are less likely to be prevalent and optimum results can be achieved. https://cts.tgcd.org.tr/pdf.php?id=216 pneumothoraxthoracotomysurgeryvideo-assisted eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 13 19 10.26663/cts.2024.003 217 article Factors affecting clinical follow-up of patients who had extended resection due to non-small cell lung cancer with vertebral invasion Bahar Ağaoğlu Şanlı 1 Fatma İlknur Ulugün 2 Fatma Mutlu 2 Üstün Andaç Dinçtürk 3 Volkan Karaçam 2 Ömer Akçalı 3 Aydın Şanlı 1 Department of Thoracic Surgery, Dr. Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, İzmir, TurkeyDepartment of Thoracic Surgery, Dokuz Eylül University, Faculty of Medicine, İzmir, TurkeyDepartment of Orthopedics and Traumatology, Dokuz Eylül University, Faculty of Medicine, İzmir, TurkeyBackground: Chest wall involvement or vertebral invasion can be detected in 8-15% of patients with nonsmall cell lung cancer. We aimed to evaluate the surgical treatment outcomes and factors affecting overall survival (OS) in those patients who underwent en-bloc resection due to vertebral and chest wall invasion. Materials and Methods: The study encompassed 15 patients with locally advanced non-small cell lung cancer who underwent anatomical lung resection and various vertebral and/or chest wall resections because of vertebral invasion at our institution between 2007 and 2019. Demographic, clinical, and pathological data of these patients were collected retrospectively and the effects of these factors on surgical outcomes and survival were evaluated. Results: The mean age of the 15 patients was 59.1 ± 10.2 years. Among the patients, six had adenocarcinoma (40%), five had squamous cell carcinoma (33.3%), one had large cell neuroendocrine carcinoma (6.7%), two had a combination of large cell neuroendocrine and adenocarcinoma (13.3%), and one had pleomorphic cell carcinoma (6.7%). Simultaneous to lung resection, hemicorpectomy in four patients (26.6%), total vertebrectomy in one patient (6.6%), partial corpectomy in three patients (20.0%), en-bloc transversectomy in five patients (33.3%), hemilaminectomy in two patients (13.3%) were performed. Two patients underwent only vertebra resection, while 13 patients underwent partial rib resection along with the vertebra. The median overall survival (OS) was 26.3 months (14.7-37.8). The postoperative survival rates were 93%, and 33% for 30-day, and 3-year respectively. When comparing OS among histopathological subgroups, no statistically significant difference was observed (p = 0.473). The median OS was 9.2 months for patients who underwent only vertebra resection, while it was 26.3 months for those who underwent vertebra and rib resection (p = 0.534). Other clinical features such as neoadjuvant treatment status, surgical margin positivity, and presence of recurrence did not exhibit a statistically significant impact on the patients' survival. Conclusions: En-bloc resection is a treatment alternative that can be successfully applied in patients with primary lung malignancies together with vertebral invasion. Nonetheless, chemotherapy, radiotherapy, or immunotherapy is advised for disease management during the postoperative period. https://cts.tgcd.org.tr/pdf.php?id=217 vertebral invasionnon-small cell lung cancerextended resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 20 26 10.26663/cts.2024.004 218 article Tracheobronchial surgical interventions Derya Balcı Köroğlu 1 Selim Şakir Erkmen Gülhan 2 Department of Thoracic Surgery, Ankara Etlik City Hospital Ankara, TurkeyDepartment of Thoracic Surgery, Health Sciences University, Faculty of Medicine, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, TurkeyBackground: Surgical treatment is almost always necessary for lesions that cause stenosis or obstruction of the tracheobronchial system. Sleeve resection is a surgical method that ensures airway continuity and reduces the loss of lung tissue by creating a primary anastomosis following the resection of the affected segment. Materials and Methods: In this study, 65 patients who underwent tracheobronchial sleeve resection and bronchoplasty at the Ankara Atatürk Sanatorium Training and Research Hospital between 1974 and 1997 were retrospectively evaluated. Patient data were obtained from medical records and surgical reports, and compared with the previous studies. Results: Of the 65 patients, 34 were male and 31 were female (mean age, 32.56 years; range, 5–65 years). Tracheal resection and reconstruction were performed in 25 patients because of stenosis and neoplasm, whereas bronchial sleeve resection and bronchoplasty were performed in 40 patients because of benign neoplasm, bronchial adenoma, bronchial carcinoma, endobronchial foreign body, and bronchial rupture. Conclusions: Resection of a small bronchial segment instead of pneumonectomy offers a curative treatment alternative for centrally localized, benign endobronchial lesions with low malignancy potential. In bronchial carcinomas, the results obtained from the complete removal of tumor tissue with sleeve lobectomy in a selected group of patients have shown that this surgical method may be an alternative to pneumonectomy. In patients with bronchial cancer, pneumonectomy should not be performed if sleeve lobectomy is possible. The high postoperative quality of life and low mortality and morbidity emphasize the superiority of this surgical method over pneumonectomy. https://cts.tgcd.org.tr/pdf.php?id=218 pneumonectomybronchial anastomosisbronchoplasty eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 27 31 10.26663/cts.2024.005 219 article Is the double edge closure technique effective against post-thoracotomy pain in the long term? Salih Bilen 1 Celal Buğra Sezen 2 Volkan Onur Yaran 3 Meral Selin Onay Mahmuti 2 Yunus Aksoy 4 Cemal Aker 2 Muzaffer Metin 2 Department of Thoracic Surgery, Bursa City Hospital, Bursa, TurkeyDepartment of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, IstanbulDepartment of Thoracic Surgery, Nazilli State Hospital, Aydın, TurkeyDepartment of Thoracic Surgery, Sakarya University Training and Research Hospital, Sakarya, TurkeyBackground: In this study, we aimed to evaluate the long-term pain and quality of life of patients following the pericostal closure (PC) and double edge closure (EC) techniques. Materials and Methods: This prospective study was conducted between April 2019 and January 2021 with 60 patients who underwent thoracotomy and surgical resection for non-small cell lung cancer Results: The median length of stay was 4 days for both the EC and PC groups (p = 0.608). Complications occurred in 11 patients (18.3%) overall, including 5 patients in the PC group (16.7%) and 6 patients in the EC group (20%). The complication rate did not differ significantly between the groups (p = 0.739). The most common complication was prolonged air leak (n = 9, 15%). Mean postoperative pain scores were lower in the EC group than in the PC group on the first 4 days and at 2 weeks (p < 0.05). While there was no difference between the two groups in terms of neuropathic pain at 6 months, an analysis of quality of life showed that the PC group experienced more perceived pain. Conclusions: The EC technique was associated with less thoracotomy pain in the early postoperative period. However, it was not found to affect neuropathic pain in the long term. https://cts.tgcd.org.tr/pdf.php?id=219 thoracotomypaindouble edge technique eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 32 37 10.26663/cts.2024.006 220 article Catastrophic injuries caused by tube thoracostomy with trocar: a series of nine cases Gizem Keçeci Özgür 1 Dilara Gürsoy 2 Ufuk Çağırıcı 2 Ali Özdil 2 Tevfik Ilker Akçam 2 Ayşe Gül Ergönül 2 Kutsal Turhan 2 Thoracic Surgery Clinic, Yüksekova State Hospital, Hakkari, TurkeyDepartment of Thoracic Surgery, Ege University School of Medicine, Izmir, TurkeyBackground: Tube thoracostomy is a procedure that is frequently used in thoracic surgical practice. However, in certain circumstances, it may lead to serious complications during or soon after the procedure. Herein, we report a series of tube thoracostomies causing life-threatening intrathoracic and intraabdominal injuries. Materials and Methods: This case series consisting of nine cases with serious organ and vascular injuries after tube thoracostomy between 2014 and 2021 are presented and the possible causes are discussed. The indications for tube thoracostomy were empyema, COVID pneumonia-related pneumothorax, traumatic pneumothorax, tracheal rupture related-hydropneumothorax during nasogastric tube application, and pleural effusion due to malignancy. A trocar was used in all patients for tube thoracostomy. Results: Malpositioned thoracic drains included five pulmonary parenchymal lacerations and pulmonary artery, spleen, liver and stomach injuries; one of each. Conclusions: In the light of these cases, all the procedures and the faults that caused those embarrassing complications have been reviewed honestly. Lessons learned from these events such as avoiding the use of trocars, and CT evaluation before the procedure may also help to prevent such complications in the future. https://cts.tgcd.org.tr/pdf.php?id=220 malpositionchest tubesinjuriestube thoracostomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 38 46 10.26663/cts.2024.007 221 article Results of surgery after neoadjuvant treatment for non-small cell lung cancer Tarık Yağcı 1 Ahmet Üçvet 2 Serkan Yazgan 3 Özgür Samancılar 4 Soner Gürsoy 5 Thoracic Surgery Clinics, Ankara Güven Hastanesi, Ankara, TurkeyDepartment of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, İzmir, TurkeyThoracic Surgery Clinics, İzmir City Hospital, İzmir, TurkeyThoracic Surgery Clinics, İzmir Medicana International Hospital, İzmir, TurkeyDepartment of Thoracic Surgery, Bakırçay University, Faculty of Medicine, İzmir, TurkeyBackground: In locally advanced non-small cell lung cancer, survival rates achieved only by surgical treatment are unfortunately lower than expected. It’s believed that survival rates can be raised by multimodal therapies including surgery. The purpose of the study is to analyse the results of surgical treatment in patients who underwent surgical resection after neoadjuvant treatment due to locally advanced non-small cell lung cancer. Materials and Methods: The patients who underwent lobectomy or pneumonectomy after neoadjuvant chemotherapy and/or radiotherapy due to locally advanced non-small cell lung cancer were included in this study. The patients were divided into two groups according to oncological treatment indication. Group A included patients who received neoadjuvant therapy due to T disease and group B due to N2 disease. The surgical interventions, pathological results, postoperative complications, mortality, recurrence, 5-year disease-free survival, and overall survival were analysed. Results: 154 patients were included in the study. 142 were men and 12 were women with a mean age of 57.7 ± 16.97 (between 35 and 77). Ninety-six patients received induction therapy due to T disease, and 58 patients due to N2 disease. Pneumonectomy was performed on 41 patients, lobectomy was performed on 113 patients (18 bronchial sleeve resection). Histopathologic results revealed squamous cell carcinoma in 96 (62.3%), adenocarcinoma in 52 (33.8) and large cell carcinoma in 6 (3.9%) patients. A complete response to neoadjuvant treatment was achieved in 19 (Group A, n = 15, group B, n = 4) patients. Postoperative pathologic results showed mediastinal lymph node metastasis in 13 (13.6%) patients in group A and, in 28 (48.3%) patients in group B, which is statistically significant. Prolonged air leak was the most common complication in both groups. Operative mortality was observed in 4 (2.6%) patients. In 82 patients 47 in group A and 35 in group B recurrence or metastasis were detected during the follow-up. 5-year disease-free survival rate was 43.2% in group A and 38.4% in group B. Five- year survival rate was 46.1% in group A and 38% in group B. Conclusions: The patients who achieved a histopathologic complete response following induction therapy had statistically significantly better disease-free and overall survival rates. Pathologically proven lymph node metastasis increased the rate of recurrence or metastasis significantly (p = 0.01). The disease-free and overall survival rate decreased significantly (p = 0.0001, p = 0.0001). It is deducible in light of these findings that patients who received neoadjuvant treatment for N2 achieved better disease-free survival and overall survival. https://cts.tgcd.org.tr/pdf.php?id=221 lung cancerinduction therapylung resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 47 50 10.26663/cts.2024.008 222 article A case of congenital total pericardial agenesis mimicking pneumothorax findings Hakkı Ulutaş 1 Mehmet Ağar 2 Nevzat Erdil 3 Muhammet Reha Çelik 4 Department of Thoracic Surgery, University of Economics, Faculty of Medicine, Medical Point Hospital, Izmir, TurkeyClinic of Thoracic Surgery, Fethi Sekin City Hospital, Elazığ, TurkeyDepartment of Cardiovascular Surgery, University of Inonu, Faculty of Medicine, Malatya, TurkeyDepartment of Thoracic Surgery, University of Atılım, Faculty of Medicine, Ankara, TurkeyCongenital pericardial agenesis has been reported as usually asymptomatic cases, operated on for other reasons and found incidentally or in autopsy reports. Herein, we present a case of congenital total pericardial agenesis mimicking the findings of pneumothorax and incidentally detected in a uniportal video-assisted thoracic surgery (VATS). Total agenesis of the pericardium, which is very rare and usually asymptomatic, has a very good prognosis and does not require additional treatment unless it causes complications. It may mimic pneumothorax findings. https://cts.tgcd.org.tr/pdf.php?id=222 pericardial agenesisuniportal VATSpneumothoraxcongenital eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 51 54 10.26663/cts.2024.009 223 article Video-assisted thoracoscopic surgery for a giant mediastinal teratoma in a pediatric patient Omer Faruk Demir 1 Murat Şahin 1 Çiğdem Gonca 1 Hilal Munzur 1 Fatma Tanrıkulu Benli 2 Yeter Düzenli Kar 3 Department of Thoracic Surgery, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, TurkeyDepartment of Pathology, Ankara Atatürk Sanatorium Training and Research Hospital, Ankara, TurkeyDepartment of Pediatrics, Division of Pediatric Hematology Oncology Unit, Afyonkarahisar University of Health Sciences, Afyonkarahisar, TurkeyMediastinal teratomas are tumors originating from the primitive germ streak. The primary treatment for these tumors is surgery, traditionally performed through thoracotomy or sternotomy. Video-Assisted Thoracic Surgery (VATS) procedures have been increasingly employed in adult patients. However, the utilization of the VATS approach in pediatric patients remains limited worldwide. Furthermore, the presence of teratomas in the anterior mediastinum poses a challenge for VATS surgery in pediatric patients, as it involves delicate anatomical structures such as the heart, vena cava, and aorta. Here we present the case of a symptomatic pediatric patient weighing 35 kilograms who presented with respiratory distress. The patient had a mass measuring 7.5 cm in diameter with indistinct borders with the pericardium. The patient underwent a successful complete surgery using the VATS technique. VATS is a reliable surgical approach for mediastinal teratoma surgery in pediatric patients, provided the surgeon has adequate experience. https://cts.tgcd.org.tr/pdf.php?id=223 mediastinal teratomamature teratomapediatric surgeryteratomavideo-assisted thoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2024-04-19 9 1 55 0 10.26663/cts.2024.013 224 article Pneumothorax or pseudopneumothorax? Tarık Yagci 1 Berkant Ozpolat 1 Division of Thoracic Surgery, Ankara Güven Hospital, Ankara, Turkey https://cts.tgcd.org.tr/pdf.php?id=224 invasive proceduresdiagnostic imagingpneumothorax