The fesasibility of thoracoscopic resection in adhesive infectious lung diseases
Talha Dogruyol1, Volkan Baysungur1, Ilhan Ocakcioglu2, Aysun Misirlioglu1, Serdar Evman1, Serda Kanbur1, Levent Alpay1, Cagatay Tezel1.
1Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, 2KarabŁk Training and Research Hospital, Karabuk, Turkey.
Background: Minimally invasive surgery is the treatment of choice in early stage lung cancer. However, experience in infectious lung disease, primarily bronchiectasis is limited probably due to presence of dense pleural adhesions, multiple lymph nodes and spiral bronchial arteries. The present study shows our experience of videothoracoscopic (VATS) lobectomy and segmemtectomy in the treatment of bronchiectasis.
Methods: Patients who underwent VATS lobectomy or segmentectomy in our clinic between April 2008-April 2015 were retrospectively evaluated. Surgery was indicated in patients with radiologically localized bronchiectasis who have also a history of recurrent lower respiratory tract infection or expectorating mucopurulent sputum. Patients were analysed in terms of age, gender, conversion rate, postoperative drainage amount, chest tube removal time, length of hospital stay, morbidity and mortality.
Results: Fourty four patients with bronchiectasis were initiated by VATS. Fourty one procedures were completed on 40 patients. One patient had bilateral resection. Fifteen patients were male and 26 were female. Average age was 31.4 (15-57) years. Fourty lobectomies and one segmentectomy was performed. Conversion rate was 6.8%. VATS was performed on twenty eight patients by three ports, eight patients by two and five patients by one port. In terms of anatomical resections eighteen patients underwent left lower lobectomy, eight right lower lobectomy, eight middle lobectomy, six right upper lobectomy, and one patient underwent lingulectomy. No postoperative major complication or mortality was observed. Prolonged air leak was observed in two patients and subcutaneous emphysema occured in two patients. The average postoperative drainage amount, chest tube removal time and length of hospital stay was 320 ml, 3.1 days (1-11) and 4.6 days (2-11) respectively.
Conclusions: Videothoracoscopy is a safe, feasible and effective treatment in the surgery of bronchiectasis with low morbidity and mortality rates. Also due to cosmetic results, patients with benign diseases such as bronchiectasis should be initiated by minimally invasive surgery options just like patients with malignancies.
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