Amaç: Sedoanaljezi eşliğinde entübasyon olmadan video yardımlı torakoskopik cerrahi (VATS) son on yılda minimal invaziv prosedürler için giderek daha popüler bir cerrahi teknik haline gelmiştir. Bu ...çalışmada ise, sedasyon veya torasik epidural anestezi kullanılamayan hastalarda sadece lokal anestezi ile uygulanan video yardımlı torakoskopi tekniğinin sunulması amaçlanmıştır.
Gereç ve Yöntemler: 2009-2019 yılları arasında, genel anestezi riski yüksek olarak sınıflandırılarak uyanık halde video yardımlı torakoskopik cerrahi yapılan 43 hasta retrospektif olarak incelendi.
10 ml izotonik ile sulandırılan 10 ml %0,5 bupivakain, cilt altına ve kas içine uygulandı. 15 dakika sonra 10 mm 0 derece videotorakoskop için toraksa tek bir port insizyonunu takiben VATS uygulandı.
Yaş, cinsiyet, başvuru yakınmaları, lateralite, efüzyon tipi, sitoloji sonuçları, hastaların komorbiditeleri, hastanede kalış süresi, efüzyon miktarı, ameliyat süresi ve patoloji sonuçları retrospektif olarak değerlendirildi.
Bulgular: Yaş ortalaması 67,32 (45-85) olan kırk üç hastanın 23’ü erkek, 20’si kadındı. En sık yakınma (n = 40) dispne idi. 22 sol ve 21 sağ hemitoraksa VATS uygulandı. 39 hidrotoraks, 4 pnömotoraks olgusu vardı. Hidrotoraks tanılı olgulardan drene edilen ortalama sıvı miktarı 1311 ml (400-4000 ml) idi. Bül nedeniyle pnömotoraks gelişen 2 olguya wedge rezeksiyon yapıldı. Hiçbir hastaya kas gevşetici veya sedasyon verilmedi.
Sonuç: Uyanık VATS seçilmiş hastalarda, kas gevşetici ve sedoanaljezi gerektirmediğinden güvenli bir tekniktir.
Objective: Non-intubated video-assisted thoracoscopic surgery (NI-VATS) with sedoanalgesia is commonly used and became an increasingly popular surgical technique for minimal invasive procedures in the last decade. In this study it is aimed to present the usage of the awake video-assisted thoracic surgery (A-VATS) technique with pure local anesthesia without sedation or thoracic epidural anesthesia.
Material and Methods: Between 2009 and 2019, 43 patients who underwent awake video-assisted thoracoscopic surgery were evaluated retrospectively. Patients who classified as high risk for general anesthetic were included in the study. In this VATS technique, after the skin preparation, 10 ml 0.5% bupivacaine with 10 ml saline was administered subcutaneously and intramuscularly. 15 minutes later, a single port incision was made to the thorax for 10-mm 0-degree single-puncture videothoracoscope.
Age, sex, complaints, laterality, type of effusion, cytology results, comorbidities of patients, length of hospital stay, amount of drained effusion, operation time, and pathology results were evaluated retrospectively.
Results: Forty-three patients (23 male, 20 female) were evaluated. The mean age was 67.32 (45–85) years. The dominant complaint (n = 40) was dyspnea. A-VATS was performed on 22 left and 21 right sides. There was 39 patients with hydrothorax, 4 with pneumothorax. The mean total fluid discharged by patients with hydrothorax was 1311 ml (400–4000 ml). A-VATS wedge resection was performed for 2 patients because of pneumothorax due to bullae.
Conclusion: A-VATS is a safer technique in selected patients because it does not require muscle relaxants and sedatives.
In this article, we present a 59-year-old male patient who was admitted to our hospital with right pleural effusion and right-sided chest pain and diagnosed as malignant pleural mesothelioma with ...thoracentesis and pleural biopsy. After the patient was determined to be operable, right parietal pleurectomy + pericardial resection + diaphragmatic resection were performed and four cycles of cisplatin and pemetrexed combination as adjuvant treatment were added. The patient was followed-up without any problem for three and a half years. At this time, left-sided chest pain and leftsided effusion were noticed. Tumor was negative in thoracentesis and pleural biopsy. Then, video-assisted thoracoscopic surgery was applied, which resulted in Stage 1a malignant pleural mesothelioma. Thoracoscopic parietal pleurectomy was performed with success. Four cycles of pemetrexed single-agent therapy was performed as an adjuvant treatment. The patient died of chronic obstructive pulmonary disease and heart failure in 57
month of the first and 21
month of the second operation while he was tumor free. To the best of our knowledge, this case is the first operated bilateral metachronous primary malignant pleural mesothelioma in the literature.
Familial association of congenital camptodactyly and arthropathy without evidence of concurrent inflammation has an autosomal recessive pattern of inheritance. We describe four children born to ...consanguineous parents in two families with congenital camptodactyly and polyarthropathy which were misdiagnosed and treated as juvenile rheumatoid arthritis (JRA) for some time. The siblings in the second family also had fibrosing pleuritis. Histopathological examination of the synovial tissues of the children in the first family revealed synovial hypertrophy and presence of multinucleated giant cells with minimal inflammation and vasculitis. On the other hand, prominent fibrosis with no inflammation was present in the synovial tissue of the elder boy in the second family. Thus, while the children in the first family had the phenotypic characteristics of congenital familial hypertrophic synovitis, the latter siblings probably represent a form of the familial fibrosing serositis.
Thoracoscopy[pet animals Sánchez Margallo, F., Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres (España); Díaz-Güemes Martín-Portugués, I., Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres (España); Correa Martín, L., Centro de Cirugía de Mínima Invasión Jesús Usón, Cáceres (España) ...
Canis et Felis (España),
(Jun 2010)
104
Journal Article
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