Gökhan ERGENE, H. Semih HALEZEROĞLU, Erdal OKUR, M. Polat DEMİRHAS, Fatma TOKAT

MEDİASTİNAL HASTALIKLARDA TEK İNSİZYON VİDEO YARDIMLI TORAKOSKOPİK CERRAHİ : TEK MERKEZLİ DENEYİM

GirişVideo yardımlı torakoskopik cerrahi (VATS), hastalarda kanıtlanmış iyileşmeler sağladığından son on yılda tüm dünyada yaygın bir popülerlik kazanmıştır. Daha yakın zamanda, konvansiyonel VATS ile karşılaştırıldığında daha minimal invaziv bir yaklaşım gibi görünen tek port VATS, torasik cerrahi patolojilerin çoğunluğu için kullanılmaya başlanmıştır. Bu retrospektif tek merkezli çalışma, tek insizyon VATS ile gerçekleştirdiğimiz mediastinal patolojilerin cerrahisinde deneyimlerimizi paylaşmayı amaçlamıştır.Gereç ve YöntemMerkezimizde Mayıs 2009-Mayıs 2019 tarihleri arasında mediastinal patolojiler için tek insizyon VATS uygulanan hastalar çalışmaya dahil edildi ve tıbbidosyaları retrospektif olarak incelendi.BulgularÇalışmaya 3-87 yaş aralığında 112 hasta (kadın, %52.7) dahil edildi. Tek insizyon VATS ile yapılan operasyonlar tanı (n=25) ve terapötik (n=87) amaçlı idi. Operasyonların hiçbirinde torakotomi ve ek insizyon gerekmedi. Ortalama operasyon süresi, tanı amaçlı prosedürlerde 26 dakika ve terapötik amaçlıprosedürlerde 53 dakika idi. Operasyon sonrası ortalama drenaj süresi 1,3 gün ve operasyon sonrası hastanede kalış süresi 2,3 gün idi. Yalnızca 5 hastadapostoperatif komplikasyon gelişti, mortalite görülmedi. Takip süresinde (1-25 ay) hastaların hiçbirinde nüks görülmedi.SonuçBu yenilikçi tekniğin, yani tek insizyon VATS’ ın, mediastinal patolojilerde teşhis veya terapötik amaçlar için kullanılması, torakotomi veya sternotomi gibi daha invaziv prosedürlere olan ihtiyacı azaltmakta ve erken iyileşme ve daha az ağrı gibi daha iyi hasta sonuçlarına yol açmaktadır.

SINGLE INCISION VIDEO ASSISTED THORACOSCOPIC SURGERY IN MEDIASTINAL DISEASES: A SINGLE-CENTER EXPERIENCE

Objective Video assisted thoracoscopic surgery (VATS) has gained widespread popularity worldwide in the lastObjective decades due to its proven improvements in patient outcomes. More recently, single-incision VATS, which has emerged to be a more minimally invasive approach as compared with conventional VATS, has begun to be used for the majority of thoracic surgical pathologies within the chest cavity. In this retrospective single-center study, we aimed to share and highlight our experience in the surgery of mediastinal pathologies through single-incision VATS. Materials and Methods Patients who underwent single-incision VATS for mediastinal pathologies between May 2009 and May 2019 in our center were included, and their medical files were reviewed retrospectively. Results The study included 112 patients (female: 52.7%; age range: 3-87 years). Single-incision VATS were performed for diagnostic (n=25) and therapeutic (n=87) purposes. No thoracotomy or additional port incision was required in any of the operations. The mean operative time was 26 minutes in diagnostic procedures and 53 minutes in therapeutic procedures. The median duration of postoperative drainage was 1.3 days, and the mean duration of hospital stay was 2.3 days. Only 5 patients developed postoperative complications, and no mortality was observed. Relapse was not observed in any of the patients during the follow-up period (range: 1–25 months). Conclusions Use of this innovative technique, i.e., single-incision VATS, for diagnostic or therapeutic purposes in mediastinal pathologies decreases the need for much more invasive procedures such as thoracotomy or sternotomy and leads to improved patient outcomes such as early recovery and less pain.

PDF

___

1. Mack MJ, Aronoff RJ, Acuff TE, Douthit MB, Bowman RT, Ryan WH. Present role of thoracoscopy in the diagnosis and treatment of diseases of the chest. Ann Thorac Surg 1992;54:403–9.
2. Shah RD, D’Amico TA. Modern impact of video assisted thoracic surgery. J Thorac Dis 2014;6(Suppl 6):S631–6.
3. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 2004;77:726–8.
4. Halezeroğlu S, Okur E, Ergene G. Single-incision video-assisted thoracic surgery for an extralobar sequestration in a child. Innovations (Phila) 2016;11:64–6.
5. Sihoe AD. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery. J Thorac Dis 2014;6(Suppl 6):S604–17.
6. Mineo TC, Ambrogi V. A glance at the history of uniportal video-assisted thoracic surgery. J Vis Surg 2017;3:157.
7. Rocco G, Martucci N, La Manna C, Jones DR, De Luca G, La Rocca A, et al. Ten-year experience on 644 patients undergoing single-port (uniportal) video-assisted thoracoscopic surgery. Ann Thorac Surg 2013;96:434–8.
8. Ismail M, Helmig M, Swierzy M, Neudecker J, Badakhshi H, Gonzalez-Rivas D, et al. Uniportal VATS: the first German experience. J Thorac Dis 2014;6(Suppl 6):S650–5.
9. Bondulich G, Gonzalez Rivas D. Uniportal video-assisted thoracoscopic surgery, Argentinian experience. J Vis Surg 2017;3:60.
10. Abu Akar F, Gonzalez-Rivas D, Ismail M, Deeb M, Reichenshtein Y, Hadas-Halpern I, et al. Uniportal video-assisted thoracic surgery: the Middle East experience. J Thorac Dis 2017;9:871– 7.
11. Fieira Costa E, Delgado Roel M, Paradela de la Morena M, Gonzalez-Rivas D, Fernandez-Prado R, de la Torre M. Technique of uniportal VATS major pulmonary resections. J Thorac Dis 2014;6(Suppl 6):S660–4.
12. Fan J, Yao J, Wang Q, Chang Z. Safety and feasibility of uniportal video-assisted thoracoscopic surgery for locally advanced non-small cell lung cancer. J Thorac Dis 2016;8:3543–50.
13. Hirai K, Takeuchi S, Usuda J. Single-incision thoracoscopic surgery and conventional video-assisted thoracoscopic surgery: a retrospective comparative study of perioperative clinical outcomes. Eur J Cardiothorac Surg 2016;49 Suppl 1:i37–41.
14. Lin Z, Xi J, Xu S, Jiang W, Wang L, Wang Q. Uniportal video-assisted thoracic surgery lobectomy in semiprone position: primary experience of 105 cases. J Thorac Dis 2015;7:2389–95.
15. Jutley RS, Khalil MW, Rocco G. Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg 2005;28:43–6.
16. Rückert JC, Swierzy M, Ismail M. Comparison of robotic and nonrobotic thoracoscopic thymectomy: a cohort study. J Thorac Cardiovasc Surg 2011;141:673–7.
17. Bedetti B, Solli P, Lawrence D, Panagiotopoulos N, Hayward M, Scarci M. Single port video-assisted thoracoscopic thymectomy. J Vis Surg 2016;2:149.
18. Caronia FP, Arrigo E, Trovato S, Lo Monte AI, Cottone S, Sgalambro F, et al. Uniportal bilateral video-assisted sequential thoracoscopic extended thymectomy. J Vis Surg 2017;3:69.
19. Migliore M, Criscione A, Nardini M, Patti F, Borrata F. Single incision extended video assisted transcervical thymectomy. J Vis Surg 2017;3:154.
20. Tacconi F, Rogliani P, Cristino B, Gilardi F, Palombi L, Pompeo E, et al. Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors. J Thorac Dis 2016;8:3704–10.
21. Wu CY, Heish MJ, Wu CF. Single port VATS mediastinal tumor resection: Taiwan experience. Ann Cardiothorac Surg 2016;5:107–11.
22. Rocco G, Brunelli A, Jutley R, Salati M, Scognamiglio F, La Manna C, et al. Uniportal VATS for mediastinal nodal diagnosis and staging. Interact Cardiovasc Thorac Surg 2006;5:430–2.
23. Delgado Roel M, Fieira Costa EM, González-Rivas D, Fernández LM, Fernández Prado R, de la Torre M. Uniportal video-assisted thoracoscopic lymph node dissection. J Thorac Dis 2014;6(Suppl 6):S665–8.