Kemal AYALP, Tuğba COŞGUN, Erkan KABA, Alper TOKER

Minimal invaziv akciğer kanserinde eski bir kontrendikasyon: Bronşiyal staplere yer yok

Amaç: Bu çalışmada bronşiyal kapatmada stapler kullanmaksızın lobektomi ameliyatlarının yapılabilirliği ve sonuçları değerlendirildi. Çalışma planı: Bu çalışmaya Aralık 2014-Ağustos 2018 tarihleri arasında robot yardımlı torakoskopik cerrahi ile lobar rezeksiyon yapılan primer akciğer kanserli toplam 108 hasta (72 erkek, 36 kadın; ort. yaş 62.1±9.8 yıl; dağılım, 19-83 yıl) alındı. Bazı hastalara primer bronşiyal kapatma (n=7) ve sleeve anastomoz yapıldı. Bu 16 hasta, bronşiyal stapler ile bronşiyal kapatma yapılan diğer lobektomi olguları (n=92) ile karşılaştırıldı. Bulgular: İki grup arasında ortalama ameliyat süresi, ameliyat sırasında kanama miktarı, ameliyat sonrası dönemde hastanede yatış süresi ve morbitite ve tekrar yatış oranları açısından istatistiksel olarak anlamlı bir fark yoktu (sırasıyla, p=0.3, p=0.5, p=0.06, p=0.4 ve p=0.63). Hastaların hiçbirinde bronşiyal fistül gelişmedi. Sonuç: Primer bronşiyal kapama ve sleeve anastomoz, torakotomiye dönmeden veya yardımcı insizyonu büyütmeye gerek duymadan robot yardımlı torakoskopik cerrahi ile güvenle ve stapler ile kapatılan bronş ile benzer başarı oranları ile yapılabilir.

An antiquated contraindication for minimally invasive lung surgery: No place to staple the bronchus

Background: This study aims to evaluate the feasibility andoutcomes of lobectomy operations without using a stapler forbronchial closure.Methods: Between December 2014 and August 2018, a total of108 patients (72 males, 36 females; mean age 62.1±9.8 years;range, 19 to 83 years) with primary lung cancer who underwentlobar resection with robot-assisted thoracoscopic surgery wereincluded in this study. Primary bronchial closure (n=7) andsleeve anastomosis (n=9) were performed in some cases. These16 patients were compared with other lobectomy cases (n=92)who had bronchial stapling for bronchial closure.Results: There was no statistically significant difference in themean duration of operation, amount of intraoperative bleeding,length of postoperative stay in the hospital, and morbidity andreadmission rates between the two groups (p=0.3, p=0.5, p=0.06,p=0.4, and p=0.63, respectively). No bronchial fistula developedin any of the patients.Conclusion: Primary bronchial closure and sleeve anastomosiscan be safely performed with robot-assisted thoracoscopicsurgery without conversion to thoracotomy, or a largerassistance incision with a similar success rate of the stapledbronchus.

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