Have Water Seal Drainage Systems Come to an End?

Background: We hypothesized that underwater seal drains are not mandatory after thoracic procedure when the visceral pleura remains intact. A small size drain with low auto-suction system (e.g., Hemovac) may be sufficient if no evidence of air leak.  Methods: This is an observational study on using low auto-suction drain as a solo pleural drain after thoracic procedures in which visceral pleura remained intact at the end of surgery. After completion of the procedure on the selected Cohort of patients, 10F Hemovac drain was inserted and fixed using 4/0 silk suture. Small collection bag, 250cc, was connected.  To ensure tight wound closure around the small caliber drain, a tunneled insertion techniques using valve mechanism for at least one intercostal space was used. Finally, by the end of the procedure, Seal/Suction test should be utilized to test for the presence of air leak either from around the drain site or disintegrated visceral pleural surface. The primary outcomes were to detect the feasibility of low-suction drain after selected thoracic procedures. The secondary outcomes were to monitor the incidence of postoperative complications related to drainage system in the short term. Results: the low-suction drain was used in 125 patients ranging between 4-86 years old. The drain was removed by the end of postoperative day 1 in 76%. Only 8 patients (6.4%) required drainage longer than 48 hours. Small apical air space (< 2cm) was detected on the immediate postoperative chest X-ray in only 8 patients (6.4%). Minimal pleural fluid was seen on the follow-up x-ray at one week in the outpatient clinic in 16 patients (%12.8). None of the patients required insertion of a chest drain or thoracocentesis. No complication related to using the Hemovac drain was reported.   Conclusion: Our observations suggest that low vacuum drainage systems are a feasible alternative to water-seal drainage systems in the remarkable number of thoracic procedures. This safe and practical drainage system could pave the way towards drainless surgery which is a culminating level for thoracic surgeons

Management of acquired bronchobiliary fistula: 3 case reports and a literature review

Bronchobiliary fistula (BBF), which often presents with bilioptysis, is an abnormal communication between the bronchial system and biliary tree. It is a complication associated with a high mortality rate and requires a well-planned management strategy. Although hydatid disease is still the leading cause, extensive surgical interventions and invasive procedures of the liver have altered the profile of patients in recent decades. This paper presents 3 cases of BBF and reviews the literature regarding the treatment options generally mandated by clinical presentation and the underlying disease

The first case of robotic left lower lobectomy in Turkey

Robotic surgery has been first applied in 2005 in Turkey. It has been applied in general surgery, urology, gynecology, and cardiovascular surgery so far. In many centers worldwide, robotic surgery has performed in thoracic surgery. Surgical indications may vary from resection to sympathectomy. The first lung operation through robotic surgery has been achieved in January 2010 in Turkey. We performed left lower lobectomy, to a 29-year-old female patient who was investigated for hemoptysis and diagnosed with bronchiectasis. The use of robotic surgery has been increasing rapidly in the field of modern surgery. Robotic resections were performed at early 2000s at thoracic surgery and became widespread. In this article, the first experience in this field in Turkey was presented

Decision-making for lung resection in patients with empyema and collapsed lung due to tuberculosis

ObjectiveCollapsed lung with associated empyema is a different clinical entity from destroyed lung. A low perfusion rate of the diseased lung is usually considered an indication for pneumonectomy in patients undergoing thoracotomy for tuberculosis. Such a criterion may not adequately reflect the functional capacity of the underlying parenchyma when the lung is collapsed.MethodsOne hundred twenty-seven patients underwent thoracotomy for tuberculosis at our hospital between 1998 and 2003. Among these, 5 (4%) patients who had a collapsed lung for more than 3 months and pleural infection were the subjects of this study. Surgery was considered after at least a 3-month course of regular antituberculous treatment. Despite no perfusions in 2 patients and 8%, 10%, and 15% perfusion rates for the remaining 3 patients, decortication alone was intentionally performed, and any kind of resectional operation was avoided.ResultsThe lung gradually filled the hemithorax between 5 and 12 days after surgery in 4 patients. The remaining patient required a thoracomyoplasty 8 weeks after the initial operation. Repeated perfusion scans 1 and 2 years after decortication continued to show no perfusion in patients who had had no preoperative perfusion. All patients were symptom free on regular follow-up between 10 months and 4.5 years.ConclusionsIt seems that the outcome is unpredictable in terms of lung expansion after decortication, which is a relatively simple procedure compared with other surgical options. We think that the risk of rethoracotomy is acceptable, considering the devastating complications and high mortality rates of resectional surgery in the treatment of such patients