Onur AKÇAY, Sinan ANAR, Sinem CANTAY, Tuba ACAR

Pnömotoraksta minimal invaziv yaklaşım: Tek port mu, iki port mu?

Amaç: Bu çalışmada pnömotoraks olan hastalarda tek port ve iki port video yardımlı torakoskopik cerrahinin etkinliği karşılaştırıldı. Çalışma planı: Haziran 2016 - Aralık 2018 tarihleri arasında, spontan pnömotoraks nedeni ile hastanemizde video yardımlı torakoskopik cerrahi uygulanan toplam 44 hasta (39 erkek, 5 kadın; ort. yaş 27.0±9.5 yıl; dağılım, 15-60 yıl) retrospektif olarak değerlendirildi. Çalışma grubu operasyon sırasında uygulanan port giriş sayısına göre tek port (n=29) ve iki port (n=15) işlem olarak iki gruba ayrıldı. İki hasta grubu yaş, cinsiyet, drenaj gün sayısı, hastanede yatış süresi, hava kaçağı gün sayısı, ameliyat endikasyonu, pnömotoraks tarafı, pnömotoraks tipi, ameliyat süresi ve komplikasyonlar açısından karşılaştırıldı. Bulgular: Yirmi iki hasta (%50) sağ taraftan, 22 hasta (%50) sol taraftan ameliyat edildi. Ameliyat süresi ortalama 81.1±19.2 dk. olup, gruplar arasında anlamlı bir fark gözlenmedi (p=0.053). İki grup arasında drenaj gün sayısı, hastanede yatış süresi ve hava kaçağı gün sayısı açısından anlamlı bir fark saptanmadı. Tek port grubunda sekiz hastada (%27.6) ve iki port grubunda beş hastada (%33.3) komplikasyon gelişti; gruplar arasında anlamlı bir fark bulunmadı (p=0.475). Sonuç: Çalışma sonuçlarımız video yardımlı torakoskopik cerrahinin tek port yaklaşımı ile pnömotoraks tedavisinde başarılı bir şekilde yapılabileceğini göstermektedir

Minimally invasive approach to pneumothorax: Single port or two ports?

Background: This study aims to compare the effectiveness ofsingle-port and two-port video-assisted thoracoscopic surgery inpatients with pneumothorax.Methods: Between June 2016 and December 2018, a total of44 patients (39 males, 5 females; mean age 27.0±9.5 years; range,15 to 60 years) who underwent video-assisted thoracoscopicsurgery due to the spontaneous pneumothorax in our center wereretrospectively evaluated. The study population was dividedinto two groups as the single-port (n=29) and two-port (n=15)procedure according to the number of port entries applied duringthe operation. Age, gender, number of days of drainage, lengthof hospitalization, number of days of air leak, the indication ofoperation, pneumothorax side, type of pneumothorax, duration ofoperation, and complications were compared between the groups.Results: Twenty-two patients (50%) were operated on the rightside and 22 patients (50%) on the left side. The mean operationtime was 81.1±19.2 min, indicating no significant differencebetween the groups (p=0.053). No significant difference wasobserved in the number of days of drainage, the length ofhospitalization, and number of days of air leak between the twogroups. Complications developed in eight patients (27.6%) in thesingle-port group and five patients (33.3%) in the two-port group,indicating no significant difference between the groups (p=0.475).Conclusion: Our study results show that video-assistedthoracoscopic surgery for the treatment of pneumothorax can besuccessfully performed via a single-port approach.

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1. Yazkan R, Han S. Pathophysiology, clinical evaluation and treatment options of spontaneous pneumothorax. Tuberk Toraks 2010;58:334-43.
2. Kutluk AC, Kocaturk CI, Akin H, Erdogan S, Bilen S, Karapinar K, et al. Which is the Best Minimal Invasive Approach for the Treatment of Spontaneous Pneumothorax? Uniport, Two, or Three Ports: A Prospective Randomized Trail. Thorac Cardiovasc Surg 2018;66:589-94.
3. Salati M, Brunelli A, Xiumè F, Refai M, Sciarra V, Soccetti A, et al. Uniportal video-assisted thoracic surgery for primary spontaneous pneumothorax: clinical and economic analysis in comparison to the traditional approach. Interact Cardiovasc Thorac Surg 2008;7:63-6.
4. Bertolaccini L, Pardolesi A, Brandolini J, Solli P. Uniportal video-assisted thoracic surgery for pneumothorax and blebs/ bullae. J Vis Surg 2017;3:107.
5. Masmoudi H, Etienne H, Sylvestre R, Evrard D, Ouede R, Le Roux M, et al. Three Hundred Fifty-One Patients With Pneumothorax Undergoing Uniportal (Single Port) VideoAssisted Thoracic Surgery. Ann Thorac Surg 2017;104:254-60.
6. Ocakcioglu I, Alpay L, Demir M, Kiral H, Akyil M, Dogruyol T, et al. Is single port enough in minimally surgery for pneumothorax? Surg Endosc 2016;30:59-64.
7. Nachira D, Ismail M, Meacci E, Zanfrini E, Iaffaldano A, Swierzy M, et al. Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax-a propensity matched bicentric study. J Thorac Dis 2018;10:S3712-S9.
8. Sawada S, Watanabe Y, Moriyama S. Video-assisted thoracoscopic surgery for primary spontaneous pneumothorax: evaluation of indications and long-term outcome compared with conservative treatment and open thoracotomy. Chest 2005;127:2226-30.
9. Goto T, Kadota Y, Mori T, Yamashita S, Horio H, Nagayasu T, et al. Video-assisted thoracic surgery for pneumothorax: republication of a systematic review and a proposal by the guideline committee of the Japanese association for chest surgery 2014. Gen Thorac Cardiovasc Surg 2015;63:8-13.
10. 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.
11. Migliore M, Deodato G. A single-trocar technique for minimally-invasive surgery of the chest. Surg Endosc 2001;15:899-901.
12. Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg 2004;77:726-8.
13. Migliore M. Efficacy and safety of single-trocar technique for minimally invasive surgery of the chest in the treatment of noncomplex pleural disease. J Thorac Cardiovasc Surg 2003;126:1618-23.
14. 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) videoassisted thoracoscopic surgery. Ann Thorac Surg 2013;96:434-8.
15. Yang HC, Cho S, Jheon S. Single-incision thoracoscopic surgery for primary spontaneous pneumothorax using the SILS port compared with conventional three-port surgery. Surg Endosc 2013;27:139-45.
16. Yang Y, Dong J, Huang Y. Single-incision versus conventional three-port video-assisted surgery in the treatment of pneumothorax: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2016;23:722-8.
17. Song IH, Lee SY, Lee SJ. Can single-incision thoracoscopic surgery using a wound protector be used as a first-line approach for the surgical treatment of primary spontaneous pneumothorax? A comparison with three-port videoassisted thoracoscopic surgery. Gen Thorac Cardiovasc Surg 2015;63:284-9.
18. Qin SL, Huang JB, Yang YL, Xian L. Uniportal versus three-port video-assisted thoracoscopic surgery for spontaneous pneumothorax: a meta-analysis. J Thorac Dis 2015;7:2274-87.
19. Kim MS, Yang HC, Bae MK, Cho S, Kim K, Jheon S. Single-port video-assisted thoracic surgery for secondary spontaneous pneumothorax: preliminary results. Korean J Thorac Cardiovasc Surg 2015;48:387-92.
20. MacDuff A, Arnold A, Harvey J; BTS Pleural Disease Guideline Group. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. Thorax 2010;65:ii18-31.