Ilhan Ocakcioglu

Is Video-Assisted Thoracoscopic Surgery Adequate in Treatment of Pulmonary Hydatidosis?

BACKGROUND Surgical management of pulmonary hydatid cyst disease has been well established. However, there are still limited data on the role of video-assisted thoracoscopic surgery in treatment of this disease. The aim of this study is to identify the advantages and disadvantages of minimally invasive surgery and compare the outcomes with patients undergoing thoracotomy in this parasitic disease. METHODS The medical records of 77 patients (53 male, 24 female) undergoing surgery for pulmonary hydatid cyst disease between January 2011 and January 2014 were reviewed. Removal of the hydatid cyst was completed using video-assisted thoracoscopic surgery in 39% (n = 30) of the patients, whereas open thoracotomy was used in 61% (n = 47). Conversion rate was 21%. Statistical analysis was used to assess differences in drainage amount, time to drain removal, length of surgery, length of hospital stay, and pain scores. Probability values of less than 0.05 were considered significant. RESULTS The drainage amount, time to drain removal, length of surgery, duration of narcotic analgesics usage, and visual analog scale scores in the thoracotomy group were significantly longer than those of the thoracoscopy group. Postoperative complications occurred in 4.3% of thoracotomy and in 13.3% of thoracoscopy patients. There was no mortality in either group. During the follow-up period, no recurrence was detected. CONCLUSIONS Video-assisted thoracoscopy for surgery of pulmonary hydatid cyst disease is superior to open thoracotomy causing less postoperative pain, a better cosmetic result, a shorter surgical time, a lower drainage volume, and a shorter time to drain removal in a selected group of patients. The fear of recurrence because of incomplete isolation of the cyst during removal was not a concern regarding our technique.

Pneumomediastinum after Tooth Extraction

Pneumomediastinum is defined as the presence of air in mediastinum. Pneumomediastinum can sometimes occur after surgery. Pneumomediastinum seen after dental procedures is rare. We presented the case of subcutaneous emphysema developed in the neck and upper chest after tooth extraction and discussed the possible mechanisms of pneumomediastinum.

A 3-cm Single-port Video-assisted Thoracoscopic Lobectomy for Lung Cancer.

Video-assisted thoracoscopic surgery is advantageous over traditional surgical practices, because of a faster postoperative recovery period, less pain, and a shorter hospital length of stay. There is no single standard technique in the video-assisted thoracoscopic surgery approach. Although these “minimally invasive” resections are habitually performed through 3-port or 4-port incision, we performed a left lower lobectomy in a 54-year-old male patient for lung cancer, through a 3-cm single-port incision.

One-port videothoracoscopic surgical intervention.

Background: One-port video-assisted thoracic surgery (VATS) has recently been proposed as an alternative to conventional 3-port VATS. To reduce pain, chest wall paresthesia, and hospital stay, lesser ports are the current direction. Materials and Methods: From 2007 to 2010, 98 patients underwent 1-port VATS procedure. The charts were retrospectively evaluated. A 2.5 cm long incision was made at the sixth intercostal space in the median axillary line. A single flexible port was used. Both the camera and the endoinstruments were introduced through the port. Patient characteristics, visual analog score, and postoperative paresthesia scores were evaluated. Results: The study enrolled 38 women and 60 men with the mean age of 49.1±1.5 years (range, 19 to 75 y). Thirty-one patients (28.6%) were diagnosed with malignant pleural effusion. Perioperative pleurodesis with talc was performed in 81% of them. One-port VATS approach was used for pleura biopsies in 77 (78.6%), wedge resection in 4 (3.8%), pleurectomy in 13 (12.4%), and biopsy with talc chemical pleurodesis in 4 (3.8%) instances. The mean operation time was 24.4 minutes (range, 15 to 50 min). No major cardiorespiratory or surgical complications were noted. The median observation time was 60 months (range, 36±81 mo). Among benign pathology patients, 56 (82.3%) of them did not complain about any pain; however, 12 patients had prolonged discomfort (2 pinprick, 6 numbness, and 4 pruritus). Conclusions: One-port VATS in selected patients are feasible and seems to be safe in thoracic surgical interventions instead of conventional 3 ports that was presented in this series.

The Feasibility of Thoracoscopic Resection in Bronchiectasis

Introduction: Minimally invasive surgery is the treatment of choice in early-stage lung cancer. However, experience in infectious lung disease, primarily bronchiectasis, is limited probably because of the presence of dense pleural adhesions, multiple lymph nodes, and spiral bronchial arteries. The present study shows our experience of video-assisted thoracoscopic surgery (VATS) lobectomy and segmentectomy in the treatment of bronchiectasis. Materials and Methods: Patients who underwent VATS lobectomy or segmentectomy in our clinic between April 2008 and 2015 were retrospectively evaluated. Surgery was indicated in patients with radiologic localized bronchiectasis who also had a history of recurrent lower respiratory tract infection or expectorating mucopurulent secretion. The patients were analyzed in terms of age, sex, thoracotomy conversion rate, postoperative drainage amount, chest tube removal time, length of hospital stay, morbidity, and mortality. Results: A total of 44 patients initially underwent VATS pulmonary anatomic resection and 41 procedures were completed on 40 patients. One patient had bilateral resection. Fifteen patients were male individuals and 26 were female individuals. The average age was 31.4 (15 to 57) years. Forty lobectomies and 1 segmentectomy were performed. The conversion rate was 6.8%. VATS was performed on 28 patients by 3 ports, 8 patients by 2 ports, and 5 patients by a single port. In terms of anatomic resections, 18 patients underwent left lower lobectomy, 8 right lower lobectomy, 8 middle lobectomy, 6 right upper lobectomy, and 1 patient underwent lingular segmentectomy. No major postoperative complication or mortality was observed. Prolonged air leak was observed in 2 patients and subcutaneous emphysema occurred in 2 patients. The average postoperative drainage amount, chest tube removal time, and length of hospital stay were 320 mL, 3.1 (1 to 11) days, and 4.6 (2 to 11) days, respectively. Conclusions: VATS pulmonary resection is a safe, feasible, and effective treatment in the surgery of bronchiectasis with low morbidity and mortality rates. Moreover, because of cosmetic results, patients with benign diseases such as bronchiectasis could be initiated by minimally invasive surgery options just like patients with malignancies.

Rib resection using a Gigli saw under thoracoscopic guidance

Introduction Despite the advantages and expanded indications of video-assisted thoracoscopic surgery, the open surgical approach is commonly preferred for the surgical treatment of rib lesions. Such an approach could lead to disadvantageous results such as increased postoperative pain and prolonged hospital stay. Despite all these handicaps, thoracoscopic resection of isolated rib resection has been reported in a small number of publications. Aim To compare the clinical outcomes of patients with isolated benign rib pathologies treated with either minimally invasive or open surgery. Material and methods The medical records of 22 patients undergoing surgery for isolated benign rib pathologies between 2013 and 2017 were reviewed. Variables statistically compared between the two groups were age, gender, symptoms, lesion size, duration of the surgery, amount of intraoperative bleeding, conversion to open surgery, volume and duration of the drainage, postoperative complications, length of hospital stay, pathological diagnosis, follow-up period, recurrence, duration of narcotic analgesic usage and pain according to visual analog scale evaluation. Results The thoracoscopic approach was superior to conventional surgery in terms of drainage volume, time to drain removal, morbidity, hospital stay, narcotic analgesic treatment duration and postoperative pain scores. All thoracoscopic procedures were concluded successfully, and conversion to open surgery was not required. During the mean 14-month follow-up period, no recurrence was encountered in either group. Conclusions This technique is a safe option for isolated benign lesions of the ribs. It is more effective in patient recovery in the postoperative period and in the management of surgical pain.

Total Rib Resection Via Uniportal Thoracoscopic Approach

In this report, we present a case specifying the availability of uniportal thoracoscopic resection of a total rib safely without the need for conventional thoracotomy. The favorable outcome of this case suggests that the uniportal thoracoscopic technique described here is a safe and successful approach for resection of costal lesions with good cosmetic results. To our knowledge, this is the first case reporting the entire rib resection via uniportal thoracoscopic approach.