Thoracic Surgery Clinic
08.10.2018

Thoracic Surgery Clinic

history

Thoracic Surgery Clinic In July 1992, Op. Dr. Ertekin Tepe was established in our hospital. In February 2013, Op. Dr. Çağlar Yıldırım Balkay, in June 2014 Op. Dr. K. Ibrahim Taylan was included in the staff and in August 2016, Asst. Assoc. Dr. With the participation of Hasan Ersöz, it has become a clinical training clinic.

The clinic, which has no inpatient service until October 2016, provided outpatient outpatient clinics and started to follow the first hospitalized patients and perform regular surgeries with 4 hospital beds allocated to it in General Surgery Service.

As a result of successful operations performed after 1 year of devoted work, the head physician of the period; Professor Dr. With the help of Nurettin Ünal, the clinic was separated from its General Surgery Department in October 2017 and received its independent service.  

The clinic currently serves as a single room with a 7-bed service and a polyclinic consisting of single rooms, private rooms with ensuite bathrooms and toilets.

Services Provided

Klin the TIA has lung surgery (wedge resection, segmentectomy, lobectomy, pneumonectomy, extended resection, metastasectomy volume reduction surgery, bulla resection for pneumothorax, cyst operations), chest wall operations (Nuss and Abramson Procedures (MIRPE) or chest wall with Rawitch Operation fixes for deformities, they thoracoplasty, various tumors or for reasons such as Tietze Syndrome chest wall resection and reconstruction ) , surgery for pleural disease (decortication, VATS), mediastinum surgery (mediastinoscopy, mediastinotomy, thymectomy, mediastinal mass excision, mediastinitis surgery),thoracal sympathectomy operation (VATS with the so-called closed method), diaphragmatic disease treatment (hernia, evantration) and some undiagnosed diseases (tuberculosis, sarcoidosis) diagnostic and treatment-oriented surgical procedures (supraclavicular lymph node excision, axillary lymph node excision, bronchoscopic interventions) are successfully applied in accordance with the requirements of evidence-based modern medicine.

In addition, trauma to the ribs, sternum (clan), clavicle (collarbone) fractures or implantation of the fracture (platinum and fracture replacement) can be performed in selected patients who have been admitted to our emergency department or to our outpatient clinic. In some cases, only observation of these fractures may be sufficient. Observations made for this purpose, operation or observation of the sail chest disease that may occur due to fracture, follow-up and contamination of the lung, which may occur due to trauma, treatment of diaphragm injuries, internal bleeding (hemothorax) to the chest cavity resulting from trauma, or tube thoracostomy applications for air accumulation (pneumothorax) inside due to rupture of lung membrane,

Cases evaluated in outpatient clinics and cases evaluated in multidisciplinary thoracic oncology councils constitute the patient flow of our clinic.

After being a training clinic, a number of local and foreign publications and papers were published by the thoracic surgery clinic.

Training programs are offered by seminars given by faculty members of the Department of Thoracic Surgery. For the 5 th and 6 th medical faculty students; chest surgery emergency, applications and theoretical issues are discussed.

  The vision of the Department; Our aim is to successfully represent our university as a high level of education with world class operations.

Polyclinic Appointment Information

An appointment can be made with MHRS from our outpatient clinic. Citizens in the outpatient clinic can be examined on the same day and as a result of the examinations performed, they can apply to perform hospitalization operations without requiring any procedure to be performed on the date of appointment given to them.

Patient Information

What Causes Lung Diseases?

As we breathe, we take the oxygen needed for your respiratory system to work. With this procedure, each breathing lungs; it is exposed to substances that can create a virus, bacteria and allergy that may pose a danger to itself.

It is a serious health problem to breathe chemical substances that may harm the lungs by occupational or living conditions.

 Smoking is the major cause of lung cancer.

 Genetic causes play an important role in many lung diseases.

What are the Symptoms of Surgical Lung Diseases?

- Shortness of breath

- Persistent coughs that last longer than a normal cold 

- Coughing or sputum blood

- Sneaking pain in the rib cage

- Side pain that may be sudden and short of breath

- Weight loss

- The cause of unknown fire

- hoarseness

Surgical Decisions in Lung Diseases

Pulmonary operations differ from other operations. This is because the lungs have to continue breathing during the operation. This necessity necessitates technological requirements in terms of anesthesia and surgery. The fact that modern lung surgeries are made since the 1950s and also the presence of heart and main vessel systems in the study area makes these surgeries more privileged.

At the moment you are at the stage of surgery, the decision of surgery is given; physicians in related departments were taken by joint council decision.

How are lung operations performed?

Pulmonary operations; It starts by entering through the chest wall to reach the lungs or the desired area. Endoscopic surgeries are VATS (video lung surgery), mediastinotomy and mediastinoscopy. These surgeries are closed surgeries performed by inserting cameras and special tools inside with the help of small holes opening into the rib cage without making large incisions. Thoracotomy is an open technique that requires a larger incision in the chest. This allows the surgeon to see the lungs directly. Your surgeon decides which method is most suitable for your disease.

Recommendations for Patients

  • If you are going to have a lung surgery and if you smoke, stop smoking. The period of non-smoking should be at least 15 days. Please note that smokers will have problems after surgery. This period will help you to avoid smoking again. Please note that smokers are disadvantaged in wound healing and sputum production. Continue your daily work until surgery, especially if you're doing sports do not cut.
  • Preoperative drug use is important. If you use drugs such as steroids, aspirin and coumadins, you should share them with your physician and use them with cut or dose adjustment. These medications can cause your surgery to be delayed because they increase bleeding. Continue to use other heart, blood pressure, chronic lung drugs and share them with your doctor.
  • One of the other problems of the patients who will be operated is the cleansing of the body. Especially in male patients, we recommend bathing the hairs in the breast area and then bathing with liquid soap in the morning of surgery and then applying hair removal cream. Infection of the scratches and wounds will occur after the surgery, the problem is in the wound.
  • Following this, the patient will be operated on the side with the surgery on the side and this will cause the patient to feel the pain of the shoulder and arm that are below the pain at the operation site.
  • A routine lung surgery lasts about 4-5 hours.
  • The patient is taken to the surgical intensive care unit and is usually serviced after 24 hours.
  • Postoperatively, the patient has a urinary catheter, a drain located in 2 thoracic cavities. Length of stay is 3-7 days. They have serum in their arms and neck and are removed in 3-4 days.
  • The patient spends the first night in the Thoracic Surgery intensive care unit where he is constantly monitored by monitors.
  • The patient is checked with daily chest radiographs.
  • One week later the actual operation suture is taken.
  • The drains of the drains are removed after 1 week after the drain is withdrawn.
  • Painkillers used in the patient may affect bowel movements, drugs for similar problems are applied to the patient. It is necessary to move as early as possible and to walk as early as possible.
  • Mild and intermittent pain, numbness, burning and itching can continue for up to 1 year. In order to cope with pain, we are using the most modern method of thoracicepiduralkateter, so patients feel very little pain. It should be borne in mind that pain feeling varies from person to person.
  • After the operation, if the patient is discharged - at the 1st week and then at the 2nd, 4th, 2nd and 3rd months, he is called to the outpatient clinic and evaluated by physical examination and chest radiography.
  • For cancer patients, lung tomography is requested at 6 months.
  • According to the course of the disease, 6 months or 1-year intervals, follow-up with lung tomography.
  • The patient who completed his 5th year without any problem is determined according to his symptoms.

Postoperative Period

 • Respiratory exercises

 A number of exercises will be taught to you by a nurse or a physiotherapist to clean your lungs immediately after the surgery, strengthen your respiratory muscles and prevent complications. The exercise tool you will use is a plastic tool called sipirometry. You're going to try to pull this device in your mouth and draw as much air as possible.  

Coughing is the most important exercise that will help you recover quickly and leave the hospital. You will be asked to cough despite your surgical pain. You will need to do this on a regular basis after you have been taught these exercises. 

• Movement exercises 

When you are in the hospital, your nurse or physiotherapist will show you a number of stretching and strengthening exercises that will make your shoulder move more freely. You may also be asked to make these movements at home during recovery. 

• Checking pain 

As soon as possible, you will begin to move in order to increase your muscle strength and blood flow. Your nurse or physiotherapist will help you to sit and walk.

Pain relievers will make your activity more comfortable. These medications will be given to you by nurses or by a special pump (epiduralkatater) under your control, which allows you to inject yourself as needed.  

 If an epiduralkatater is worn on your back before the operation, it may take a few days to relieve your pain.

• What You Should Do After Discharge

Continue breathing exercises that are taught to you by your physiotherapist.

Take a walk to ensure blood circulation and strengthen your muscles, but avoid body tightening, weight lifting exercises and driving a few weeks.

Use your pain medication as described to reduce your pain and thus make it easier for you to move and breathe deeply.

Discuss with your doctor who will follow you about your recovery and the consequences of the surgery.

• Home Improvement 

A few weeks after surgery, you will gain a little more energy and power every day. At first, it can be difficult to breathe and you can stay breathless. Don't overload yourself and rest when you get tired. Your doctor will tell you what you can and cannot do while he is recovering.

• Wound Care

Your stitches will be taken on the 10th day after your doctor checks. You can take a shower a week after the stitches are taken. When you take a shower, wash the area with warm water and mild soap. During the few weeks after the surgery, the bruising and bruising in the wound and surrounding area are normal. However, in the presence of discharge, please consult your doctor. 

• Starting the Activity 

Stay away from all activities such as heavy lifting that will deteriorate your injured wound for 6 gibi8 weeks after surgery. Start to walk and regulate your circulation, and increase your lung capacity and strength. 

Taking painkillers before activities will make your breathing comfortable. You'il have a shortness of breath for a few weeks. This is normal and improves over time. As you begin to feel better, you will start activities that demand more power. 

Ask your doctor how long you should wait before you start having sex, driving and working.

Conditions to apply to my doctor

Tell your doctor if you have any of the following after your surgery:

  • Shortness of breath 
  • Redness and discharge in your skin 
  • Sudden and sharp chest pain 
  • Fire height above 37.5ºC
  • Coughing bright red colored blood to arrive
  • Difficulty in swallowing 
  • Hoarseness  
  • Sudden palpitation

    Some Breast Surgery Disorders and Operations

    1) Lung Cancer

    Cancer Definition

     A large group with a common aspect is used for a wide variety of diseases: uncontrolled disintegration of cells of an organ or tissue. As a result, tumor (tumor) is formed. Malignant or malignant tumors are outside the normal growth control of the organism. The ır low çoğ cells multiply in such a way that they are not braked. They penetrate into the surrounding tissues and grow in them, destroy it, enter the bloodways and lymph vessels, and reach other body organs with blood flow and lymphatic flow. Cells of resistant tumors can reside and replicate in other organs - resulting in sister tumors (metastases) resembling resistant tumors. Lung cancer is one of the types of cancer that is resistant to tumor.
    Cells of blood cancer spread throughout the body with blood. In some of these species, nodes and tubers are formed, and they are very similar to the hard-wearing tumors.

    Lung cancer shapes

    When the tumor tissue is examined under the microscope, it is determined that there are four types of bronchiocarcinoma (lung cancer). The most common genus is the epitheliacinomas of the epithelium (secretory) cells and the adenocarcinomas originating from the gland cells. Approximately 20 percent of tumors are small cell carcinoma (lung cancer). In addition, 10 percent of large cell carcinoma (lung cancer) and other rare lung cancers are also seen. But for treatment planning, a distinction is made between non-small-celled and small-cell lung cancer (bronchiocarcinoma) groups. In the non-small cell lung cancer group, adenocarcinomas, plate epithelarsinomas and large cell carcinomas are collected. But in this field, especially with the help of molecular biology methods that improve gradually, it is expected that the subtypes of lung cancer will be characterized and handled separately. Based on this, it is hoped that the treatment options will be reached according to the biology and growth regulation of the tumor.
    Benign tumors can also occur in the lung, such as fibrous connective tissue, cartilage tissue, or improperly formed tissues. But these are rare and less than 10 percent. A symptom of benign tumors is that they usually slow growth and repel healthy tissue where they are, but do not kill them.

    Causes And Risk Factors   

  • bronchoscopy

    Bronchoscopy is one of the most important diagnostic methods in case of suspected lung cancer. The meaning of bronchoscopy is the use of an optical device that can be inserted into the bronchi and branches of the bronchoscope called bronchoscope and which allows viewing and examination of those regions. It is even possible to enter into bronchial branches with a few millimeters in diameter. Patients are given a sedative drug and anesthetized regionally using a spray of the mucous membranes of the nose, throat, larynx and large bronchi. The bronchoscope device is inserted through the mouth. In some particular cases, for example, if a tumor narrows the bronchi, a rigidbronchoscope is used. In this case, the examination is always done by applying full narcosis. Biopsy is performed with the help of a collet that passes through the bronchoscope. This means that tissue samples are taken from suspicious areas of the bronchial walls. Taking tissue samples from the original lung tissue is performed through a needle inserted through the bronchial wall. Suspected tissue samples taken are subjected to pathological examination. If cancer is cancer, the exact characteristic of the tumor type is determined. The bronchial washing method called 'bronchial lavage' or the scratch-off of the bronchial wall results in individual cells removed from the tissue for the purpose of microscopic examination. This type of examination is called cytological examination and the cancer-specific changes in the tissue can be detected with this method. It is possible to reach a diagnosis based on tissue and cell samples taken in more than 70 percent of patients. For example, if it is not possible to reach a suspicious area in the outer part of the lung by a bronchoscope, a biopsy is performed by entering the chest wall from the outside with a thin needle. A long, thin needle is inserted into the suspicious area under CT control and some tissue is absorbed. This method has been applied frequently recently. There is no complication if the procedure is done appropriately.

  • Defining the prevalence of the disease

    If the suspicion of having a bronchial carcinoma is confirmed and the tumor type is determined histologically or cytologically, the metastasis of the disease (whether it is propagated from the site to the other regions) is investigated. For this purpose, the region and organs where the metastases of lung cancer are located are examined. These are particularly liver, adrenal glands, bone, lymph nodes in the mediastinum area, and brain. CT (computed tomography), Bone Scintigraphy and Ultrasound can be performed. This method is often used for the detection of the disease, as well as for the exact distribution of a lung cancer. This examination covers the entire thoracic region and upper abdomen and provides examination of the liver, adrenal glands and lymph nodes. The computer of the device calculates the cross-sectional images of each area. Tumors can be detected even if they are smaller than 5 millimeters. In some cases, an additional ultrasound examination may be necessary. MRI should be used in special cases (mediastinum invasion, large vessel involvement, posterior sulcus tumors and chest wall deaths). 

  • Mediastinoscopy

    In most cases, the cells of lung cancer are transported over the lymph vessels to other areas. Often, these cells are collected in lymph nodes in the mediastinum region; It is seen. In particular, if the computerized tomography of the lymph nodes appears to be enlarged (if the axis is larger than 1 cm) and which therapy should be performed and whether an operation should be performed, the mediastinum region (mediastinoscopy) is appropriate, especially if it depends on the condition of these lymph nodes. For this reason, the tissue is cut just below the breast bone under anesthesia and a catheter called mediastinoscope is inserted into the space between the lung wings. With this method, there is a conclusion about whether there is a tumor in that area. Positron Emission Tomography which is abbreviated as PETprovides information about the metabolism movement in the tissues. It is successful in CT imaging of lymph nodes in the area between the heart and lung, especially mediastinum. If the PET examination shows a negative result, there is probably no involvement of the lymph nodes. Tissue diagnosis is needed if PET is positive. The PET-CT device, which combines the positive aspects of PET and CT methods and applies them in a single process as a combination, gives more successful results, especially for anatomical location. This method is currently being implemented in a small number of treatment centers. This method is included in the field of routine diagnostic use.

    staging

  • Searching for metastases

    It may be appropriate to draw a computer tomography of the brain with the aid of contrast medium or to take a bone scintigraphy, especially in the form of small cell lung cancer or prior to the planned operation of regional advanced non-small cell lung cancer. If CT (computer tomography) is not present in patients with brain metastasis symptoms, MRI is valuable. Bone scintigraphy in case of suspected bone metastasisApplied. Depending on the phosphorus, a solution and a technetium (a metallic element) supplied to the blood vessels are collected in the bones. The places where this element is collected can be displayed on the body with the help of a special camera, because the used technetium will rays for a short time. However, since bone sintigram shows increased bone metabolism, including benign changes, a X-ray examination or MRI examination is required for a more reliable diagnosis. PET is very valuable in bone metastases. If the staging will be done with PET, it is unnecessary to perform other examinations.

    Checking the general health status Before performing an operation, it should be decided whether the patient's general health condition is suitable for a surgical procedure and to what extent lung tissue should be cut or removed or radiotherapy will be applied. The examinations to be carried out for this purpose include careful investigation of the respiratory function and an electrocardiogram (ECG). One-second volume and total capacity in active breathing are the most important data in lung function tests.

    Disease Stage: The examinations described above are used for tumor TNM system.According to the tumor spread, size and local (regional) spread (T), lymph node relapse (N, nodules) and metastases (M) are taken into account. The numbers behind the letters provide information on the size and distribution (T1-4), the number and location of the diseased knot (NO3) and the distant metastases (M0 or M1) with or without the disease. For example, T1 N0 M0 refers to a small tumor that has not spread to the lymph and does not cause metastasis. The stage of this disease determines the mode of treatment. The precise determination of the TNM stage is only possible after surgical removal of the tumor. In this case, the pathologist report has a small kanıt p pat letter in relation to the TNM stages and is pathologically proven, for example pT1pN0pM0. Planning of treatment The type of cancer, the stage of the disease, and the patient's overall health score determine treatment. It is also very important whether lung cancer is small cell. In non-small cell cancer, surgery should be performed if possible, in small cell lung cancer is performed in Stage I a. It is possible to treat by radiation, ie radiotherapy, and other drugs that can rinse the cell growth by administering chemotherapy. They can be applied either individually or in addition to the operation method. Chemotherapy is a priority in small cell carcinoma. If the patient's general health condition is not good, especially if the heart and lung are poor in efficacy, some forms of therapy may be limited or not practiced, or they will be very tiring for the patient who has lung cancer. The physiological age of the patients does not play an important role in this regard.
    Lung cancer treatment should be performed by experienced clinicians and physicians.

    Treatment

    If local cancer is defined in the staging studies, the general condition of the patient and, in the meantime, especially if the heart and lung function are appropriate for a surgical intervention, always prior to the operation option in non-small cell lung cancer. On the other hand, the operation option in small cell lung cancer is not in the foreground except in the very early stage.  
    The aim of the operation is to remove the tumor completely (complete resection) by taking healthy lung tissue around the tumor. The lung lobes, lemps and mediastinum lymph nodes that are diseased in the operation are also scrubbed (lymph node dissection) and subsequently examined for tumor. In order to be complete, there should be no tumor in the border areas of the most distant lymph node. The most common mode of operation is the removal of the diseased lung lobe (lobectomy).
    If the tumor exceeds the limit between two lobes, both lobes are cut (Bilobectomy). It is possible to take one of the lungs in the main bronchus (central, central) tumors near the large and lung entrance (pneumonectomy). However, because the operation risk is higher and due to the effects of pneumonectomy operation, this surgical procedure should be applied only in meticulously planned cases.

    Organ-protective operation (sleeve resections): Today, lung surgeons are carrying out operations to maintain most of the lung tissue where possible. If there is a healthy lung tissue behind the tumor in the central part of the lung, and the feeding of this tissue will be discontinued as a result of the operation, the ends of the cut bronchi and possibly the large blood vessels can also be reconverted and stitched (bronchoplastic operation and angioplastic operation). In this way, the remaining lung pieces are fed again with air and blood and their functions can be maintained.
    If the tumor is adjacent to organs and tissues adjacent to the lung, they are also taken by operation. Chest wall, aorta, diaphragm and caval vein resections and constructions can be performed if there is no spread to the lymph gland. Our site has been examined under the title of Extended Akc Surgery operations. How the case is actually and what width should be performed can only be seen during the surgical procedure.
    Remediation of the remaining lungs A lung that has been rarely damaged before the operation, the removal of the lung tissues can be compensated to a certain extent due to the loss of functional surface, increasing the number of cells. The remaining lung tissue expands to compensate for the disappearing part, and thus a severe shortness of breath usually does not occur after the operation

    2) Mediastinoscopy

    What is mediastinoscopy?The virtual space that we call mediastinum is simply the space between the heart and the lungs; a special tool (mediastinoscopy) to enter the neck through the neck through the outside of the front of this area to be reached by reaching the area to be taken here. The patient is admitted to the hospital on the morning of surgery, in fact, after being completely cleared, he knows that he will be sent home but we prefer to keep the patient in hospital one night.

    When mediastinoscopy is performed:The most common site of lung cancer is the pre-operative staging. If cancer cell is seen in lymph node biopsy taken from here, surgery is not recommended and it is directed to other treatment methods. The second most commonly used for the diagnosis of lymph nodes and masses located in the mediastinum. Is there a risk? It doesn't take great risks when it is done in experienced hands but it is possible to encounter some problems in the process which is rich in the vein and life area that should not be forgotten.

    Side effects seen:

  • Bleeding
  • Breathing Pipe Injuries
  • Stroke
  • Esophageal injuries
  • Hoarseness
  • Wound inflammation
  • hematoma
  • Cardiac arrhythmia

    Who does not perform this procedure: Excessive goiter, patients with anomial artery aneurysm, permanent tracheostomy (to breathe from the throat to the airway to the hole) does not apply in patients. It can be applied for the second time, and according to the situation when the patient had undergone cardiac surgery.

    3) Video Assisted Thoracoscopic Surgery (VATS)

    VATS is a closed surgery technique using several small incisions. No big incisions like open surgery. When finished, maybe one or more tubes are placed in the rib cage to drain the liquid and air. The aim is to examine the chest wall and lungs accompanied by a video camera to obtain tissue for diagnosis.

    Basically everything that can be done with open surgery can be done with VATS. However, in cases that prevent the camera or hand tools from reaching (adhesions, previous illnesses or surgeries, etc.), open surgery may be required.

                Postoperative period 

    You can be taken to the service or intensive care unit after the operation. In the beginning you may feel exhausted and thirsty. You will be given fluids that will pass your pain through the vein. Monitors monitor your breathing and heart rate.

               You can go home after your chest tubes come out. The length of hospital stay usually ranges from 1 to 4 days.

    4) Chest Wall Deformities

     

    Chest wall is located inside the structure of the chest cavity of the chest in the collapse of the chestnut chest, also known as the chest is called pectus excavatum .

    This group is the most common anomaly, 1 / 300.-400 in live births. It is not as rare as it is thought. These are very typical images of children: narrow and thin chest, hook shoulder, extrovert slats and weak posture. The shoemaker's chest usually occurs at birth or in the first years of life, and is recognized by the mother and relatives. Although rarely regressed, adolescence will probably worsen the depression. About a quarter of the scoliosis (shift of the spine) due to this situation should investigate. Asthma disease may be present in 5% of the cases. It is 4 times more common in males than females. The etiology of the collapse is not known precisely for the etiology of cartilage ribs. There is an increased family predisposition. 37% had a family history of chest collapse (shoemaker's chest).

    This deformity is tolerated in childhood. As the age grows, there may be pain in the deformed cartilage rib after pain and pain in the left breast area. After exertion, palpitations and heart rhythm disorders can be observed. A heart murmur can be heard after a short exercise. Electrocardiographic changes may occur due to the displacement of the heart. When the deformity is corrected in chest wall, lung function is improved. This improvement in delayed corrections is somewhat difficult (no improvement after 40 years of age). In cases with Marfan syndrome, more severe collapse is observed.

    The chest wall causes a pitting in the anterior wall of the right ventricle of the right heart, especially when it is moved backwards. With the correction of the collapse, the pitting in the heart's ventricle is also improving. The correct evaluation of the severity of the pectus excavatum deformity will be made and it is of great importance for the good of the postoperative results. Various methods have been arranged for grading the severity of the depression. All of these methods mainly use the distance between the most sedimentary location of the sternum and the spine.

    For respiratory and cardiac problems, the greater the preoperative sedimentation, the more recovery should be expected. Many workers have attributed symptomatic disorder in pectus excavatum to volume reduction in the chest cavity. Even in normal individuals, this relationship is difficult to prove since there is a wide range between the limits of cardiopulmonary function. This is entirely dependent on physical work and body habits.

    We will try to explain the treatment of chest abnormalities that we are trying to explain above. The treatment of chest collapse is surgery. So there is no treatment outside the surgery. We will talk about two of the most common methods, and in particular Nuss (MIRPE) will try to explain the operation. In the other method, the Ravitch Method, the rib cage is opened and the deformed cartilage ribs are removed except for rib 2. A wedge-shaped piece is then removed from the posterior portion of the breastbone and sutured with a wire suture. The process is terminated by placing a wire behind the breastbone. This process, unfortunately, is not as short as we've described, it takes about 3 hours and is bleeding, and 2 drains are created to get the blood out. The wire is removed after about 10 days. length of hospital stay and return to actual life is long. At least 6 months can not do sports.

    As a further method, the method of raising the bone with the bone after the breast bone has been reported. The procedure, which is minimally invasive and is now known as the Nuss Procedure, was developed and perfected over the years. The complications of this minimally invasive procedure are quite rare. Pneumothorax is the most common complication but usually does not require tube thoracostomy. Incorrect placement of the bar may sometimes require resettlement and there is a risk of infection, as in all surgeries, but so far this rate has been reported to be less than 1%. Metal allergy has been described, but very few. Pain is felt, but this can be controlled by epidural catheters and painkillers. The recovery period is 4-5 days. Postoperative pain control, respiratory physiotherapy, attention is paid to patient / parent education. The pectus bar is removed between two and four years after placement. The procedure is performed under general anesthesia. Patients may be discharged one or two hours after the bar is removed. When the long-term results are considered, the probability of recurrence is less than 5%. In addition to all these advantages, very rare cases have been reported with this method, and sometimes the cases of heart injuries have been reported. It is essential to keep this risk in mind, which may result in great problems until death, and perhaps the only advantage of the other method (Ravitch) is that this possibility is much less. Patients may be discharged one or two hours after the bar is removed. When the long-term results are considered, the probability of recurrence is less than 5%. In addition to all these advantages, very rare cases have been reported with this method, and sometimes the cases of heart injuries have been reported. It is essential to keep this risk in mind, which may result in great problems until death, and perhaps the only advantage of the other method (Ravitch) is that this possibility is much less. Patients may be discharged one or two hours after the bar is removed. When the long-term results are considered, the probability of recurrence is less than 5%. In addition to all these advantages, very rare cases have been reported with this method, and sometimes the cases of heart injuries have been reported. It is essential to keep this risk in mind, which may result in great problems until death, and perhaps the only advantage of the other method (Ravitch) is that this possibility is much less. In addition to all these advantages, very rare cases have been reported with this method, and sometimes the cases of heart injuries have been reported. It is essential to keep this risk in mind, which may result in great problems until death, and perhaps the only advantage of the other method (Ravitch) is that this possibility is much less. In addition to all these advantages, very rare cases have been reported with this method, and sometimes the cases of heart injuries have been reported. It is essential to keep this risk in mind, which may result in great problems until death, and perhaps the only advantage of the other method (Ravitch) is that this possibility is much less.

    The deformities of the chest wall are not collapsed and the deformities are called pectus carinatum deformity. It does not usually cause a decrease in heart or lung function. The biggest requirement for treatment is that the patient is unhappy with this appearance.

    Its treatment is surgery just like the pectus excavatum deformity. Likewise, the MIRPE method (Abramson Procedure) can be placed under the skin of the steel bar placed under the skin to the normal position of the chest wall, again by making the large incision with the Ravitch Method, the connection of the sternum bone cartilage can be cut, if necessary, the length of the cartilage can be shortened. The difference of the Abramson procedure from the Nuss procedure for pectus excavatum patients is not entered in the chest cavity, the bar is sent over the bone. Therefore, no serious complications such as cardiac injury are observed. The pre- and post-operative images of a patient operated by Abramson method were shared below.

     

     

    5) Air bags and lung volume minimization operations

    In lungs, air sacs may be formed due to congenital or chronic bronchitis and emphysema. These pouches do not breathe in themselves, they swell to occupy an area and prevent the operation by compressing the lungs to do the work of breathing. Therefore, treatment is the surgical removal of these sacs.

    What does lung volume reduction surgery mean?

    Lung volume reduction surgery is a treatment option for patients with severe emphysema and chronic bronchitis (COPD). Surgical removal of damaged lung tissue, usually around 20arlı30 percent of both lungs. Removal of diseased areas reduces the volume of the lung and makes its function better.     

    Surgery should be done jointly by a thoracic specialist and thoracic surgeon.

    Postoperative period

    You will be transferred to the intensive care unit where you will be closely observed. Tubes coming out of your chest allow the blood and liquid to come out. Necessary fluid and medicines are given to the lines that are attached to the vein. Monitors record your heart rate and the amount of oxygen in the blood. You can spend one or more days in this particular surveillance section before being picked up in your room.

    You will be given medicines to help you be more comfortable during your recovery. Again, during this process, breathing and facilitating exercises will be given to increase. The duration of hospital stay may vary from patient to patient but may take up to a week or longer

    6) pneumothorax

    It is called the accumulation of air between the lung membranes. It is divided into two groups as Spontaneous and Traumatic.

  • Primary Spontaneous Pneumothorax (PSP)

It is frequently seen in males of 20 4030 years of age, in pre-puberty and after 40 years of age. It is seen in the US every year for 20,000 people and causes an economic loss of $ 130 million. It is seen 5 to 6 times more in males. There is a tendency for familial tendency in women. The most common cause of PSP is the rupture of air sacs in the lung apex (upper part). The explosion of the blade may be in exertion or rest. It is not known exactly why these air pouches (bleps) occur. There are a number of arguments, but no one has ever gained certainty.

  • More negative pressure on the top of the lung,
  • Ischemic causes,
  • Cigaret
  • Infections.

The higher the negative pressure in the air at the apex in the weaker asthenic types, the longer. There is a direct proportion between the amount of cigarettes and the incidence of SPS. It is more common in smokers. The recurrence rate was found to be 70% in the patients who continued to smoke and 40% in the patients who had quit smoking. This factor is independent of smoking. Changes in atmospheric pressures are more common in periods. People who have bullets in their lungs can cause an explosion during air travel. ClinicChest pain is usually sudden onset. It is localized to the exploding part. Pain at rest is pain. Hypertension, moderate tachycardia, hypotension, cyanosis if tension is considered pneumothorax. On physical examination: there is a decrease in breathing sounds and less participation to the pneumothorax. The trachea is pushed to the opposite side (sheft), intercostal space opening on the pneumothorax side, decrease in vocal fremitus, hyper-resonance. In one part is present pleural fluid. Computed tomography of the thorax shows small pneumothorax and bullae.

Treatment Treatment includes evacuation of air, controlling air leakage, and reducing the likelihood of recurrence. Observation and nasal oxygen therapy, aspiration, tube thoracostomy, video-assisted surgery, thoracotomy can be performed.

Surgical Indications Air leakage lasting more than 7 days, recurrent pneumothorax, ticketing (bilateral) pneumothorax, history of pneumothorax on the opposite side, in patients with pneumonectomy (in single lungs), occupational causes (pilot and divers, long road captains, bus drivers, climbers), hospital people who live far away, those who have a very important job in professional terms.

7) Tracheobronchial Stenting

It is an implant placed in the airway to expand the narrowing structure (stenosis) in the trachea or bronchus to keep the airways open, or to prevent any stenosis or obstruction after removal of the obstruction.

Migration of the stent is the possible side effects of the occlusion with secretions. For these reasons, patients are frequently admitted to the hospital after stent insertion and bronchoscopic procedures can be performed. Sometimes it can cause serious consequences such as ulcers (wounds) and fistulas (mouth to mouth) in the trachea or bronchial wall. Rarely, after prolonged use, it may be filled with intravenous inflammatory secretions, leading to infection.

Stent is placed under general anesthesia with the help of rigid bronchoscope. The stent is inserted through the rigid bronchoscope placed in the mouth of your mouth. Stenosis or obstruction should be removed by rigid bronchoscope before the stent.

8) Endoscopic Thoracic Sympathectomy (ETS)

• Under what circumstances is surgery performed?

- Hand sweats

 - Underarm sweating

 - Facial sweating

 - Flushing

 - Foot sweats

 - Coldness and bruising at the fingertips (reynaud phenomenon)

These cases can also be corrected in the same surgery. However, it is especially applied in hand and underarm sweats.

Foot sweats are not done, but if there are sweats with the above sweats, 60% of the patients will have foot sweats.

What is ETS (Endoscopic Thoracic Sympathectomy)?

By entering the chest cavity with a video camera to adjust the sweating nerve (sympathetic ganglion) titanium clips placed, or nerve damage (electrocauther burned) process.

Persons who have previously undergone lung pain or lung surgery are not eligible for ETS.

Advantages of ETS

- The average processing time is 30 minutes.

- When the patient wakes up, the hands are dry and warm.

- It leaves a very small mark.

- Less pain occurs

Recovery and recovery of the effects of the surgery will occur in a short time. Patients are discharged on the 2nd day of surgery and can perform daily activities on the same day.

98 percent in hand sweats, 80 percent above the armpit sweating, foot sweating is not done for a successful result of about 25 percent of foot sweats.

Are there complications of ETS?

Reflexed sweating (increased sweating in other parts of the body) is the most common side effect with a rate of 20 böl50%. But 2 edic3% is disturbing. Another rare side effect is the sweating during meals.

Allergic reactions to anesthetic agents and drugs, which may occur rarely or in every surgical procedure, bleeding, infection and adjacent organ injury may occur.

Sometimes air in the chest cavity (pneumothorax) may develop. But most of them disappear spontaneously and do not create problems.

The so-called Horner syndrome (reduction in the eyelid, diminution in the pupil and a reduced sweating rate) may return to normal within a few months, albeit very rarely.

Waking up after surgery 

After surgery, you will be transferred to your service oil. Necessary fluid and medicines are given to the lines that are attached to the vein. Monitors record your heart rate and the amount of oxygen in the blood.

You will be given medicines to help you be more comfortable during your recovery. Again, during this process, breathing and facilitating exercises will be given to increase.