Should wide chest wall resections and reconstruction intimidate thoracic surgeons?

Background: This study aimed to compare patients in whom wide chest wall resection and reconstruction or primary closure was performed. Methods: A total of 63 patients who underwent chest wall resection and reconstruction between January 2018 and December 2022 were included in the retrospective study. The patients were divided into two groups: the first group, which included 31 patients (14 males, 17 females; mean age: 44.6±16.4 years; range, 16 to 71 years) who were closed primarily, and the second group, constituting 32 patients (25 males, 7 females; mean age: 54.6±17.2 years; range, 9 to 80 years) who underwent reconstruction with plates and meshes. Results: There was no significant difference between the two groups in terms of smoking and diabetes. Primary chest wall or metastatic tumor was determined in 33 patients; benign tumor and trauma were determined in 30 patients. The difference between the two groups in mean defect diameter (p=0.009), mean number of plates used (p<0.001), and mean hospital stay (p<0.001) was statistically significant. However, there was no significant difference in terms of complications (p=0.426). Conclusion: Wide chest wall resection and reconstruction is a safe and feasible surgical procedure when compared with primary closure.

Transthoracic robotic plication for diaphragmatic elevation.

Background: This study aims to evaluate the feasibility, safety, and efficacy of transthoracic robot-assisted surgery for diaphragmatic plication and to describe our surgical approach in detail. Methods: Between January 2014 and January 2020, a total of 13 patients (11 males, 2 females; median age: 55 years; range, 24 to 70 years) who underwent diaphragmatic plication with the robotic system were retrospectively analyzed. The changes in the Medical Research Council dyspnea scale, forced expiratory volume in 1 sec, body mass index, and quality of life scale scores of the patients before the operation and at the first year of follow-up were examined. Results: Twelve of the operations were performed on the left side. The median pre- and postoperative Medical Research Council dyspnea scores were 2 (range, 1 to 4) and 1 (range, 1 to 4), respectively, indicating a statistically significant improvement (p=0.008). A significant improvement was detected in the forced expiratory volume in 1 sec of the patients in the first year after surgery (p=0.036). In terms of quality of life parameters, only, in the physical health subscale, the scores were statistically significantly different in the pre- and postoperative first-year follow-up (p=0.002). Median time to chest tube removal was 1 (range 1-5, IQR=0,5) days. Median total length of hospital stay was 2 (range 2-18, IQR=3) days. Conclusion: Owing to its technical dexterity, the robot enables the plication to be performed easily and safely. Late improvement in respiratory functions is reflected in quality of life.

Surgical Management of Multiple Hydatid Cysts in Second Trimester Pregnancy.

Although hydatid cysts are an endemic infestation, experience in surgical management of pregnant women is quite limited. This report aims to share the results and experiences gained from the management and surgery of a woman with a second trimester pregnancy who presented with asphyxia because of the rupture of a giant bilateral hydatid cyst.

Demographic characteristics of pectus deformities across Turkey.

BACKGROUND: This study aims to investigate the demographic characteristics and familial inheritance of pectus deformities across Turkey. METHODS: Demographic characteristics of a total of 5,098 patients (5,028 males, 70 females, mean age 23.6 years; range, 1 to 56 years) with pectus excavatum and pectus carinatum admitted to our outpatient clinic between January 1996 and December 2018 were retrospectively analyzed. The distribution of the patients across the country was made according to seven regions and 81 provinces. Familial inheritance was investigated using patients" data obtained from the clinical records and telephone calls. RESULTS: Of all patients, 3,330 (65.3%) had pectus excavatum and 1,768 (34.7%) had pectus carinatum deformity with a pectus excavatum-to-pectus carinatum ratio of 1/1.9. In the Southeast Anatolia region, the rate of pectus excavatum was lower than the overall average and higher in the Marmara region (p=0.009 and p=0.037, respectively). In the Southeast Anatolia region, the rate of pectus carinatum was higher than the general average and lower in the Marmara region (p=0.001 and p=0.003, respectively). Kastamonu, Çankiri, Karabük, and Sinop were the most common provinces for pectus deformity cases. Family history was positive in 39% of pectus excavatum and 43% of pectus carinatum patients. All regions showed a similar distribution in terms of the presence of family history. CONCLUSION: This is the first study to report the distribution of pectus deformities in Turkey and the high frequency of pectus deformities in certain regions and provinces of Turkey indicates familial inheritance.

How to do depends on where it settles: Mediastinal parathyroid adenomas.

BACKGROUND: In this study, we aimed to evaluate demographic characteristics, preoperative adenoma localization, surgical techniques selected according to the size and localization of adenoma, and clinical results of patients undergoing mediastinal parathyroid adenoma excision. METHODS: Medical records of a total of 11 patients (4 males, 7 females; mean age 52.6 years; range, 25 to 65 years) who underwent excision of mediastinal parathyroid adenoma in our clinic between January 2011 and June 2019 were retrospectively reviewed. Data including demographic characteristics, complaints, preoperative serum calcium, phosphorus, and parathyroid hormone levels, preoperative imaging methods, surgical method, localization and size of adenoma, length of hospital stay, and duration and amount of drainage were recorded. RESULTS: Adenoma was localized in anterior mediastinum in seven patients and in the middle mediastinum in four patients. The mean diameter calculated by taking into account the longest diameter of parathyroid adenoma was 21.1 mm. The mean drainage duration was 3.5 days in two patients undergoing median sternotomy, five days in one patient undergoing thoracotomy, 1.2 days in three patients undergoing video-assisted thoracoscopic surgery, and 0.6 days in five patients undergoing robotic surgery. CONCLUSION: Minimally invasive approaches such as videoassisted thoracoscopic surgery and robotic-assisted surgery are safe and effective approaches for excision of mediastinal parathyroid adenoma.

A rare cause of pneumomediastinum and subcutaneous emphysema: Tooth extraction.

Pneumomediastinum is defined as the presence of free air between mediastinal structures. Although most of the cases occur spontaneously or due to traumatic reasons, they may rarely be observed after dental procedures. It is considered that the use of high speed air turbin drill during dental procedures might cause mediastinal emphysema. High-pressured air dissects the soft tissues starting from the impaired dento-alveolar membrane and reaches the mediastinum. Contaminated fluid and air can reach the mediastinum after the deterioration of the intraoral barrier and may result in highly mortal descending mediastinitis. In this article, we present a 53-year-old female patient of pneumomediastinum developing after tooth extraction using high-speed air turbine.