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    Can intrapleural alteplase treatment be an alternative to videothoracoscopic deloculation and decortication in pleural empyema?
    (TERMEDIA PUBLISHING HOUSE LTD, 2021) Kermenli, Tayfun; Azar, Cebrail
    Introduction: Chest tube drainage is the first step in the management of complicated pleural effusions that have turned into empyema. In cases where adequate drainage cannot be provided or deloculation is required, intrapleural fibrinolytic therapy or surgical deloculation can be performed. Alteplase is a suitable agent for intrapleural fibrinolytic therapy. On the other hand, video-assisted surgery is an effective and minimally invasive treatment option for lung re-expansion. Aim: The effect of intrapleural alteplase irrigation applied through the thoracic tube in the treatment of pleural empyema was investigated and whether it could be an alternative technique to video-assisted thoracoscopic surgery was evaluated. Material and methods: The results of patients who were treated for empyema in our clinic were evaluated retrospectively. Twenty-one patients who underwent tube thoracostomy + intrapleural alteplase and 28 patients who underwent VATS deloculation were included in the study. Results: The study included 35 male and 14 female patients. There were 21 patients in group 1, and 28 patients in group 2. The mean age was 50.6. The average length of thoracic tube stay was determined as 7.1 and 6.96 days. The duration of hospital stay in this group was 6.73 and 6.35 days. In 17 (81%) patients in group 1, the treatment was discontinued without the need for surgery. Conclusions: VATS-D is an effective option in the treatment of pleural empyema. However, as seen in our study, intrapleural alteplase application is at least as effective as VATS-D in terms of treatment success.
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    First experiences in non-intubated, video-assisted thoracoscopic surgery: A single-centre study
    (Termedia Publishing House Ltd., 2021) Kermenli, Tayfun; Azar, Cebrail; Gündoğdu, Zafer
    Introduction: Video-assisted thoracoscopic surgery (VATS) with non-intubated technique is safely performed under spontaneous breathing and sedation. With this surgery, many complex thoracic surgical interventions can be successfully applied. Aim: We shared the results of our patients who underwent mediastinal biopsy, pleural biopsy, lung wedge resection, pneumothorax surgery, and pleural delocculation with non-intubated VATS. Material and methods: Patients who underwent surgery with non-intubated VATS between March 2015 and May 2020 in our clinic were included in the study. The patients were evaluated in terms of many factors such as age, gender, applied surgical intervention, diagnosis, side of surgery, duration of surgery, and time of hospital stay, and the results were recorded retrospectively. Results: Twenty of the patients were male and 12 were female. Regarding comorbid diseases in our patient group, 13 had extrathoracic malignancy, 7 had hypertension, 6 had heart disease, 5 had chronic obstructive pulmonary disease and asthma, and 4 had diabetes mellitus. Pleural drainage and biopsy were performed in 10 patients and wedge resection in 8 patients. Bullectomy and apical pleural abrasion were performed in 6 patients, mediastinal mass biopsy was performed in 4 patients, and delocculation was performed in 4 patients due to empyema. Conclusions: The non-intubated VATS approach can be safely applied in procedures such as lung resections, pleural or mediastinal interventions, and pneumothorax surgery. With this technique, the absence of intubation and mechanical ventilation facilitates the return to normal respiratory physiology, and we think that the recovery time of the patient, the duration of hospital stay, and treatment costs are reduced.