Suat Erus

Robotic lung segmentectomy for malignant and benign lesions

OBJECTIVE Surgical use of robots has evolved over the last 10 years. However, the academic experience with robotic lung segmentectomy remains limited. We aimed to analyze our lung segmentectomy experience with robot-assisted thoracoscopic surgery. METHODS Prospectively recorded clinical data of 21 patients who underwent robotic lung anatomic segmentectomy with robot-assisted thoracoscopic surgery were retrospectively reviewed. All cases were done using the da Vinci System. A three incision portal technique with a 3 cm utility incision in the posterior 10(th) to 11(th) intercostal space was performed. Individual dissection, ligation and division of the hilar structures were performed. Systematic mediastinal lymph node dissection or sampling was performed in 15 patients either with primary or secondary metastatic cancers. RESULTS Fifteen patients (75%) were operated on for malignant lung diseases. Conversion to open surgery was not necessary. Postoperative complications occurred in four patients. Mean console robotic operating time was 84±26 (range, 40-150) minutes. Mean duration of chest tube drainage and mean postoperative hospital stay were 3±2.1 (range, 1-10) and 4±1.4 (range, 2-7) days respectively. The mean number of mediastinal stations and number of dissected lymph nodes were 4.2 and 14.3 (range, 2-21) from mediastinal and 8.1 (range, 2-19) nodes from hilar and interlobar stations respectively. CONCLUSIONS Robot-assisted thoracoscopic segmentectomy for malignant and benign lesions appears to be practical, safe, and associated with few complications and short postoperative hospitalization. Lymph node removal also appears oncologically acceptable for early lung cancer patients. Benefits in terms of postoperative pain, respiratory function, and quality of life needs a comparative, prospective series particularly with video-assisted thoracoscopic surgery.

Alternative paratracheal lymph node dissection in left-sided hilar lung cancer patients: comparing the number of lymph nodes dissected to the number of lymph nodes dissected in right-sided mediastinal dissections

OBJECTIVE Removing or sampling lymph nodes from the bilateral paratracheal area through a left thoracotomy is not a standard procedure in patients with lung cancer. The aim of this study was to evaluate the feasibility of a technique without ductus arteriosus division and mobilization of the aortic arch and to compare the number of lymph nodes resected in left-sided dissections to the number of lymph nodes removed in right-sided mediastinal dissections that are routinely performed in clinical practice. METHODS A total of 93 patients with hilar lung cancer were evaluated. A prospective study was conducted on 51 patients with primary left-sided hilar lung cancer, who underwent left thoracotomy and paratracheal lymphadenectomy between January 2008 and January 2010. The number of nodes dissected in these patients was compared with the number of nodes dissected in 42 patients with right-sided hilar lung cancer by right-sided mediastinal dissection within the same period. RESULTS The mean number of resected nodes in the bilateral paratracheal area via left thoracotomy was 8.4 (2-18 nodes). The distribution from 4R-4L-2L-2R was as follows: 3.3-2.5-0.5-2.1, respectively. Six patients (11.7%) were diagnosed with occult N2, and two (3.9%) of these patients also had N3 disease concomitantly. The number of dissected nodes from the ipsilateral station 2 via right-sided versus left-sided thoracotomy was 1.6 versus 0.5 (p=0.000), whereas the number of dissected nodes from ipsilateral station 4 via right-sided versus left-sided thoracotomy was 3.3 versus 2.5, respectively (p=0.1). The number of dissected nodes from the contralateral station 2 via right-sided versus left-sided thoracotomy was 0.2 versus 2.1 (p=0.000), whereas those numbers from the contralateral station 4 via right-sided versus left-sided thoracotomy were 1.0 versus 3.3, respectively (p=0.000). CONCLUSIONS Lymphadenectomy of the paratracheal area via left thoracotomy without ductus arteriosus division and mobilization of the aortic arch is technically feasible. From these data, regardless of approach, more lymph nodes are obtained from the right paratracheal space; this appears to be due to the fact that there are more right-sided paratracheal lymph nodes.

Robotic segmentectomy: far beyond choice

With the progress of the technology, video-assisted surgeries have been developed in thoracic surgery as well as the other branches. With the widespread use in the 2000’s, robotic surgical systems had also found a place within the field of thoracic surgery. First in benign diseases and then in parallel with the increasing experience, it started to be used in cancer surgery which requires more technical skill. It was shown in various articles that it can be used in a wide area from wedge resections to pneumonectomy.

Role of Surgery in the Treatment of Masaoka Stage IVa Thymoma

PURPOSE To analyze the role of surgery in patients with Masaoka stage IVa thymoma treated with multimodality therapy. METHODS Of 191 patients undergoing surgery for thymoma in our department between January 2002 and December 2015, 39 (20.4%) had Masaoka stage IVa. Histopathological tumor type, myasthenic status of the Osserman-Genkins score, Masaoka stage at the first surgery, neoadjuvant treatment, number and type of surgeries, and survival rates were recorded. RESULTS Thymoma B2 was the most common histopathological tumor type (n = 16, 41%). Twenty-six (66.7%) patients underwent primary surgeries for Masaoka stage IVa thymoma, whereas nine (23.1%) underwent secondary surgeries and four (10.3%) underwent tertiary surgeries for pleural or pericardial recurrences. Median survival was 132 ± 25 (82-181; 95% confidence interval [CI]) months. Overall 3-, 5-, and 10-year survival rates were 93%, 93%, and 56%, respectively. CONCLUSION Surgical treatment should be considered as a completion modality to oncological therapy and has the potential to provide long-term survival of Masaoka stage IVa in patients with thymoma. The type of surgery should be determined based on the invasiveness of the lesion.

Video-Assisted Thoracoscopic Resection for Destroyed Lung

Advances in surgical techniques have indicated that video-assisted thoracoscopic pneumonectomy is a safe alternative to open pneumonectomy. However, indications for video-assisted thoracoscopic pneumonectomy are controversial. We describe two patients who underwent left pneumonectomy because of destroyed lungs and speculated about the tight adhesions, enlarged lymph nodes, enlarged bronchial vessels, and access incisions. Two patients were operated by two different approaches mainly; anterior and posterior, because of the degree of contralateral lung herniation. Both of them experienced a safe perioperative period.

Aortoözofageal fistül: Olgu sunumu

Aortoenteric fistula is a rare and fatal condition that usually results from aortic aneurysms and is secondary to aortic surgery. The other causes are foreign bodies, infections, esophageal or bronchial malignancies, and caustic ingestions. Endoscopy shows a pulsatile submucosal mass, bluish-gray discoloration of the esophageal mucosa due to intramural hematoma, fistula orifice, esophagitis, and esophageal ulcers. Biopsy should not be performed. Emergency surgery should be performed in the presence of aortoesophageal fistula suspicion secondary to clinical presentation and imaging studies. Herein, we report a patient with aortoesophageal fistula who admitted to the hospital due to hemoptysis, dyspnea, nausea, and vomiting.