LAPAROSCOPIC SURGERY IN LUNG CANCER
Laparoscopic techniques developed in thoracic surgery shorten the post operative period of recovery in patients with lung cancer.
In recent years, as in all surgical specialties in thoracic surgery minimal invasive methods are preferred. These methods are videothoracoscopic and robotic surgeries. VATS technique which is a video-supported technique of surgery can be applied currently. If there are no negative conditions regarding the patient and if it can be applied with an oncologically competent surgery, resection with VATS should be applied first. With this technique, the surgery is conducted with the help of special tools, camera and two or one small incision(s) and the surgeon’s hand does not enter the chest cage. The main advantage of these operations is minimizing the complications. Also the patient feels less pain after the surgery and the duration of stay in the hospital decreases. Even if oncological treatment is needed, the response of the patients to this treatment is more successful.
SURGERY IN CHEST WALL DEFORMITIES (Pektus Ekskavatum, Pektus Karinatum)
Pectus excavatum is the most common form of chest wall deformity in children. It usually occurs at birth or in the early years of life. During the rapid growth period of 14 -15 years, the existing deformity becomes more obvious.
Although there are treatment options other than surgical treatment, with minimal invasive techniques (MIRPE and MIRPC) or their modification with open methods, the only option for treatment for today is surgery.
The optimal age for the operation in pectus excavator is still under discussion. According to some surgeons, recurrence risk is high in patients who are operated before puberty. For this reason, most surgeons found adolescence (10-16 years) as the best time to undergo surgery. The upper age limit for pectus carinatum (pigeon chest) is not known, but patients over 60 years of age with acceptable symptoms can be operated. In experienced hands, the rate of complication development is very low. There are three to five days of hospitalization.
Evantration is the permanent total or partial elevation of diaphragm without damaging the connected parts to the ribs and organs connected. This is a rare condition in adults. The aperture may occur after primary or acquired phrenic nerve damage. In patients with a diaphragm elevation or diaphragm paralysis, dysponea is the main symptom. In patients with a diaphragm elevation or diaphragm paralysis, the function of the diaphragm is lessened or lost due to the lack of movement. Thus, because of an adjustment disorder between the lungs and thorax wall either important changes occur in breathing or the breathing becomes disrupted.
While the treatment of diaphragm elevation was conducted with open methods in the past, today, diaphragm plication techniques with transthoracic or transabdomnial methods have been developed in a minimally invasive way. Once the diaphragm is brought to normal position, the pressure in the lungs is eliminated and the capacity of the exertion increases.
SURGERY IN EXCESSIVE SWEATING
Sweating under the hand and arm is caused by excessive activation of sympathetic system inside the chest cage and excessive work of sweat sockets. That’s why it’s not a symptom of disease. However, we note that some tests must be carried out in patients. We want all patients to be seen by an endocrinologist before they come to us. We want the thyroid tests to be done. There are certain metabolic tests and we look at whether these are done or not. If the patient has’nt completed them, we send them to the endocrinology or internal medicine clinic or vice a versa if they have already evaluated the patient. The first thing we look at in the patient is the thyroid. Because the excess function of the thyroid accelerates metabolism, as well as it causes an increase in sweating. Whether the patient’s family has a history of excessive sweating, sweating during sleep, sweating or both sides, the area where patient lives, the heat status of the patient’s business environment and the clothing habits of the patient are put into question. After the evaluating all of these, it is the responsibility of the thoracic surgery to decide the operation for the appropriate patients.
The importance of surgery in excessive sweating.
Mostly surgeries performed by experienced surgeons offer a high percentage of permanent solution. The operation is performed under general anesthesia and the excess sweating on the underarms, hands and face permanently ends.
After the trachea comes the main bronchus and then the bronchi. The abnormal and permanent expansion of the bronchi as a result of the deterioration of the integrity of the muscle and elastic structure on their walls is called bronchiectasis. While bronchiectasis can be caused by congenital reasons it can also occur later in life. Anatomical disorders, vascular disorders, silia layer disorders on the respiratory passages and immune system deficiencies play a role on bronchiectasis caused by congenital reasons. Aside from the negative effects of smoking, frequent lung infections, foreign bodies that block the bronchus, situations that constrict the bronchus (the suppression of the lymph glands around the lungs), aspiration pneumonia can be the case in bronchiectasis that occurs later in life. While bronchiectasis is most commonly seen in the lower left lobe, it can affect all the bronchi of the lungs.
Firstly, a drug therapy is administered in bronchiectasis and in persevering cases, surgery comes into play. If the infection becomes resistant in medical treatments and disrupts the comfort of the patient’s life, the surgery takes place. Surgery is not recommended in common bronchiectasis, if the bronchiectasis is limited, in other words, localised, better results are obtained. In surgery, we perform robotic or videotorochoscopic operations with laparoscopic methods. After these operations, the patient can recover significantly. If patients neglect or delay surgery, the infection can cause abscess development, amyopia, hemoptysis, brain abscess, or in rare conditions, sepsis.
In normal conditions, there is no air between the membrane that is adherent to the lung and the outer membrane which covers the inner membrane of the chest wall. In pneumothorax, which is also called lung expulsion, air enters between these two membranes and accumulates. If the leak is large, it can put pressure on the heart and the opposing lung. With the event called bulla and bleb, small and large air sacs develop on the long and these are the most common cause of a spontaneous pneumothorax. With the burst of these air sacs, air breaks through chest cavity and the lung goes out like a balloon. While this condition can be caused by hereditary lung diseases it can also be caused by impacts from the external.
Primary spontaneous pneumothorax is an affliction seen more in smoking, tall, lean and lightly humped young males and also it targets professional groups such as pilots and divers. Sudden severe chest pain and dyspnoea are the most common symptoms of a serious pneumothorax. This chest pain is so severe that it is often confused with a heart attack. On the other hand, pneumothorax is a common disorder in COPD patients. The primary complaint in these patients is dyspnoea. Therefore, in a situation of chest pain and dyspnoea, a patient with COPD must also be examined for a possiblity of pneumotorax before being passed off as having a COPD attack.
In surgery, laporoscopic videotoracoscopic and robotic operations are performed with a small incision. The chances of success of surgery are high yet if the patients do not abstain from smoking, the disease can reoccur.
MINIMALLY INVASIVE SURGERY FOR SECONDARY LUNG CANCER
The secondary lung cancers occur with the spread of other tumours to the lungs. For the suitable patients, these secondary cancers which have metastasized to the lung can make open or closed surgery possible with a multidisciplinary treatment approach depending on their spread status.