Video-assisted thoracoscopic laser ablation in the treatment of primary spontaneous pneumothorax Primer spontan pnömotoraks tedavisinde video yardimli torakoskopik lazer ablasyon

Amac: Bu calismada video yardimli torakoskopik (VAT) lazer ablasyon tekniginin primer spontan pnomotoraks (PSP) tedavisinde uygulanabilirligi arastirildi. Ca­lis­ma­pla­ni:­Ocak 2006 Haziran 2012 tarihleri arasinda komplike PSP olan 60 hasta calismaya alindi. Hastalar prospektif olarak her biri 30 hastadan olusan iki gruba randomize edildi. Grup 1’deki hastalara VAT ile stapler kullanilarak blebektomi veya bullektomi yapilir iken grup 2’deki hastalara VAT ile laser ablasyon yapildi. Plevral abrazyon her iki gruptaki hastalara Marleks yama kullanilarak yapildi. Tum hastalara tek bir toraks dreni (28 F) konuldu. Iki grubun ameliyat suresi, komplikasyon sayisi, hastanede yatis suresi, tup torakostomi suresi ve PSP nuks oranlari karsilastirildi. Bul gu lar: Grup 1’de medyan stapler kullanimi 1.6 (1-4) iken, grup 2’de medyan enerji kullanimi 2700 J (1800-3700 J) idi. Grup 1’de medyan ameliyat zamani 31 dk. (17-65 dk.), grup 2’de 34 dk. (15-59 dk.) idi. Gecikmis akciger ekspansiyonu grup 1’de sadece iki hastada (%6), grup 2’de 22 hastada (%75) (p≤0.05) goruldu. Ortalama hastanede yatis suresi grup 1’de 2.75 (2-4) gun, grup 2’de 3.7 (2-10) gun idi (p≤0.05). Toraks tupunun kalis suresi grup 1’de 2.3 (1-7) gun, grup 2’de ise 7.9 (2-14) gun idi (p<0.001). Grup 1’de iki hastada (%5) PSP nuksu gorulurken, grup 2’de bir hastada toraks tupu cekimi sonrasi akciger kollapsi goruldu. So­nuc:­Isil hasar nedeniyle gecikmis akciger ekspansiyonu gorulebilmesine karsin, VAT laser ablasyon tedavisinin, VATS bullektomi ile karsilastirilabilir sonuclari ile guvenilir ve etkili oldugu soylenebilir. Anah tar soz cuk ler: Bullektomi; lazer; primer spontan pnomotoraks; video yardimli toraks cerrahisi. Background:­This study aims to investigate the feasibility of the video-assisted thoracoscopic (VAT) laser ablation technique in the treatment of primary spontaneous pneumothorax (PSP). Methods: Between January 2006 and June 2012, 60 patients with complicated PSP were included. Patients were prospectively randomized into two groups including 30 patients in each. Video-assisted thoracoscopic blebectomy and/or bullectomy with staplers was performed for group 1, whereas VAT laser ablation was performed for group 2. Pleural abrasion using the Marlex mesh was performed in both groups. A single chest tube (28 F) per patient was inserted. The operating time, number of complications, duration of hospital stay, duration of tube thoracostomy, and PSP recurrence rate were compared between the groups. Results:­The median stapler use was 1.6 (1-4) in group 1, and the median energy use was 2700 J (1800-3700 J) in group 2. The median operating time was 31 min (17-65 min) in group 1 and 34 min (15-59 min) in group 2. Delayed lung expansion occurred in only two patient (6%) in group 1 and 22 patients (75%) in group 2 (p≤0.05). The mean hospital stay was 2.75 (2-4) days in group 1 and 3.7 (2-10) days in group 2 (p≤0.05). The duration of chest tube use was 2.3 (1-7) days in group 1 and 7.9 (2-14) days in group 2 (p<0.001). There was two PSP recurrence (5%) in group 1 and one lung collapse following chest tube removal in group 2. Conclusion:­ Although delayed lung expansion due to thermal damage may develop, VAT laser ablation appears to be safe and effective with comparable results to those of VATS bullectomy.