Bronchopleural Fistula: Causes, Diagnoses and Management
By Güntuğ Batıhan and Kenan Can Ceylan
Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and pleural space. This clinical condition, which has high mortality and morbidity, is one of the major therapeutic challenges for clinicians even today. BPF may result from a lung neoplasm, necrotizing pneumonia, empyema, blunt and penetrating lung injuries, and a complication of surgical procedures. Lung resection is the most common cause of BPF, and this chapter will focus more on this topic. Frequency ranges from 4.5 to 20% after pneumonectomy and from 0.5 to 1% after lobectomy. Several risk factors have been defined in the development of postoperative BPF; preoperative radiotherapy, pulmonary infection, diabetes, right pneumonectomy, a long bronchial stump, residual cancer at the stump (R1 and R2 resection), and the need for postoperative ventilation (especially with high PEEP). BPFs are divided, based on the time elapsed since surgery, into early or late fistula. This grouping is important in management of patient treatment. In early BPF, surgical treatment is generally the preferred treatment modality, whereas in late BPF, conservative approach is preferred. The management of BPF is still one of the most complex challenges encountered by the thoracic surgeons; so prevention is the best way to manage postoperative BPF.
Part of the book: Diseases of Pleura
The Role of Minimally Invasive Surgery in the Treatment of Lung Cancer
By Güntuğ Batihan and Kenan Can Ceylan
Lobectomy plus regional lymph node dissection remains the gold standard treatment method in early-stage lung cancer. However, with the demonstration of the safety and efficacy of minimally invasive approaches, the expression of surgery in this statement, replaced by thoracoscopic anatomical lung resection. Clinical studies have demonstrated the superiority of VATS in terms of postoperative pain, drainage time, length of hospital stay, and complications, moreover, long-term oncologic results are similar or better than thoracotomy. Therefore, VATS lobectomy is the preferred surgical method in early-stage lung cancer. Different surgical techniques are available in VATS and can be modified according to the surgeon’s personal experience. Uniport can be applied as well as two or three port incisions. In this book section, I plan to focus on VATS lobectomy, technique-related tricks, complication management, and long-term oncologic results in early and locally advanced lung cancer.
Part of the book: Lung Cancer
Minimally Invasive Approaches in the Thoracic Surgery
By Güntuğ Batıhan and Kenan Can Ceylan
Minimally invasive techniques in thoracic surgery have made great progress over the past 20 years and are still evolving. Many surgical procedures performed with large thoracotomy incisions in the past can now be performed with much smaller incisions. With many studies, the advantages of minimally invasive surgery have been clearly seen, and thus its use has become widespread worldwide. Today, minimally invasive surgical methods have become the first choice in the diagnosis and treatment of lung, pleural and mediastinal pathologies. Minimally invasive approaches in thoracic surgery include many different techniques and applications. In this chapter, current minimally invasive techniques in thoracic surgery are discussed and important points are emphasized in the light of the current literature.
Part of the book: Advances in Minimally Invasive Surgery
Surgical Anatomy of the Lungs
By Güntuğ Batıhan
Anatomical lung resections are specialized procedures that require a good knowledge of anatomy and high surgical experience. Individual isolation and dissection of hilar structures, including pulmonary arteries, pulmonary veins, and bronchus, are the basic steps of anatomic lung resection. Today, lobectomy is still the gold standard treatment method in many lung pathologies, especially in early-stage lung cancer. In-depth knowledge of anatomy, including variations, is required to perform this surgical procedure safely and successfully, which has a relatively high risk of intraoperative complications. Technological developments and the spread of minimally invasive surgery paved the way for the recording of procedures and their use for educational purposes and that ushered in a new era in surgical education. These developments in video-assisted surgery, which is an excellent advantage for patient comfort and education, have made the digital exploration of the surgeon impossible and increased the importance of theoretical anatomy knowledge even more. This chapter will discuss the lobar distribution of the lung, tracheobronchial airway, vascular structures, and their variations.
Part of the book: Essentials of Pulmonary Lobectomy