All you need to know about thoracoscopic surgery in Turkey

All you need to know about thoracoscopy

When there are different symptoms and signs of certain diseases, thoracoscopy is a medical procedure that can be useful to help doctors in Turkey to reach a final diagnosis.

Video assisted thoracoscopic surgery (vats) is often used to examine changes in the center of the chest (the mediastinum), which runs between the lungs from the lower neck to the diaphragm and from the sternum to the spine. Tissue outside the mediastinum but within the pleural cavity and chest cavity may also be evaluated.
Measures to treat the disease in question are often taken during the thoracoscopy procedure.

Thoracoscopy is performed through three small holes in the patient's chest through which surgical instruments and an endoscope equipped with a camera are inserted
An illustration of the instruments used in video-assisted thoracoscopy and how it is performed in Turkey

Reasons that may require thoracoscopy

Doctors use diagnostic thoracoscopy when changes are present in various organs in the chest or when they are suspected.
This can include the lungs, diaphragm, thymus, which is part of the immune system, esophagus and lymph node disease as well as other changes in the mediastinum (the center of the chest) such as diagnosing and sampling cysts and Lumps within the pleural cavity and chest cavity. Video thoracoscopy may also be performed if fluid buildup (effusion) in the pleura or in pericardium.

A pleural effusion can be watery, purulent, or bloody (hemophotra) and can sometimes contain neoplastic cells.

Symptoms

Symptoms depend on the specific disease that the diagnostic thoracoscopy reveals. There is often shortness of breath and pain on examination.

Diagnosis

It is important that the patient is questioned about previous complaints and illnesses and a physical examination can also be helpful, as the lungs in particular are listened to and utilized. Relevant findings can often be represented using imaging methods, such as an X-ray, ultrasound or computerized tomography (CT) scan. In addition, a blood test is performed where attention is paid, for example in an empyema (purulent collection), to signs of inflammation.

differential diagnosis

Possible diseases must be distinguished from each other, which is why diagnostic thoracoscopy is performed.

treatment

preventative treatment

There are many scenarios and options for non-surgical internal treatment, such as giving medications or performing general measures by a specialist.

Surgery

Thoracoscopy is performed under general anaesthesia. Ventilation is provided through the lungs on the healthy side.

Thoracoscopy is a medical procedure that involves making small incisions in the thoracic cavity in the space between the ribs, through which a precise optical device called a thoracoscope with a special video camera, surgical instruments and thoracoscopic instruments can be inserted.

The surgeon can follow the image from the small camera on the screen, evaluate the organs and tissues and, if necessary, perform the procedures and take a biopsy.
Depending on the results, different procedures can be taken through the chest wall.

Thoracoscopy in Turkey can be used to remove affected lymph nodes
A picture showing the removal of lymph nodes by thoracoscopy in Turkey

A special device is used for suction pleural effusion. Which leads to the removal of restrictions on the lung. If there is a purulent effusion (pleural empyema), a tube is inserted to drain the secretion and rinse it several times a day with antibiotics and antiseptic chest fluid.

If there are adhesions and tissue roughness (scaling) in the pleura, which often occur due to inflammation or effusion, they can be loosened or removed (exfoliation).
Sometimes the roughness can also be removed from the tissues of the lungs directly, and in other cases, medical intervention with traditional open surgery is necessary for treatment.

In the case of pericardial effusion, the solid pericardial tissue is opened by opening a 2×2 cm opening. This allows fluid to drain into the pleural space, so that excessive pressure that threatens the heart is prevented or relieved. Because of the small amount, the fluid can usually be easily absorbed by the pleura.

When a malignant tumor is suspected, a specialist in endoscopy will remove larger portions of the pleura and then subject them to tissue examination (biopsy). If the suspicion of cancer is confirmed, the remaining portion of the pleura must also be removed endoscopically and/or in the vast majority of cases, open thoracic surgery is necessary for this. As a result, respiratory function is not affected or impaired but only slightly.

If it is found that pleural effusion is a reason for the presence of a malignant tumor and a cause for the spread of cancer cells in the pleura (pleural cancer), the entire pleural cavity is considered an affected area.
For this purpose, talcum powder is inserted into the cavity.
This can also be useful in pleural mesothelioma, which begins in the pleura. This substance prevents the liquid from pooling again.
After this method is used, respiratory function is also unrestricted or barely restricted.

If there are abnormal results or injuries in lungs , it may be necessary to partially remove lung tissue or sew up the lung.
A special sewing device can be used for this.
When the tissue is removed, the lungs, diaphragm, and mediastinum move slightly in the direction of the defect.
This usually has little or no functional effect. If a cavity appears despite the displacement of the organ, it fills with fluid on its own.
An infection may occur in this place, in which case the inflammatory secretions must be placed and drained.
In a few cases, it may be necessary to modify the rib cage space by removing several ribs.

Esophageal bulges (the diverticulum) and cysts (the thickening associated with a cavity) can also be removed during endoscopy. The injury is sutured using a technique with special tools.
Additional esophagogastroduodenoscopy allows to find the right place.

Enlarged lymph nodes can also be removed by thoracoscopy, in Malignant tumors for example.

Thoracoscopy can also reveal cysts in the middle layer of the membrane (mediastinal cysts), which are in the pleura or pericardium and are usually congenital. This is more difficult with bronchial cysts because they are stuck in the surrounding tissue. Therefore, an open operation must be performed in the case of bronchial masses.

In the case of tumors or enlargements, the thymus gland will often have to be removed. The thymus is an organ in which some immune cells develop in childhood and adolescence, but transform into fatty tissue in adulthood.
And thoracoscopy makes sense here because fewer scars are created.
However, due to the complex situation and vascular supply, the operation can be difficult, so it is often necessary to convert it to an open operation. The removal of the thymus does not result in any defects or diseases.

Following appropriate procedures, one or two drainage tubes are usually inserted into the patient's chest cavity in order to be able to absorb the wound fluid and thus enable the lungs to expand to a normal size.
After several days, the tubes can usually be pulled back through the chest wall.

Possible additional procedures for operation

When there are unexpected results or complications, it is necessary for the doctor to expand the operation or modify the method. It may be necessary to switch from thoracoscopy to open surgery.

Thoracoscopy complications

Surrounding anatomical structures or organs can be injured during thoracic surgery.
This can lead to primary and secondary bleeding, and even nerve damage, which can often lead to temporary sensitivity disturbances or paralysis.
Injury to the phrenic nerve can lead to breathing difficulties, injury to the visceral nerve (vagus nerve) can lead to an irregular heartbeat, and weakness of the vocal cord nerve can cause voice disturbances and possibly shortness of breath.

Furthermore, inflammation, wound healing disturbances, and visible scarring with potential functional or aesthetic effects can occur.
Likewise, allergic reactions of varying severity cannot be ruled out.
Interventions in the thymus gland can lead to a type of muscle weakness (myasthenia gravis).
Surgical sutures can also slip into the esophagus, causing problems in the esophagus, stomach, and chest.

Instructions for patients

before the operation

Medicines that adversely affect blood clotting, such as the so-called Marcomar or Aspirin, often have to be discontinued or parted in consultation with a cardiologist.

Smoking can lead to wound healing disorders and disabilities after the operation, so the patient should stop before the endoscopic operation if possible.

After the operation

 Special breathing exercises, physical therapy and chest swimming are very useful after the operation to maintain health and reduce problems after such surgeries.

If you notice any abnormalities or just pains that may indicate a complication, do not hesitate to contact your doctor.

Regular checkups should be done after the malignant findings are removed.

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Common Questions

How long it takes to recover depends on what was done during the procedure. But you will probably need to rest at home for about one to two weeks at a minimum.

according to Studies Video-assisted thoracoscopic surgery is a safe and effective alternative to anatomic thoracotomy in patients with lung cancer

The cost of laparoscopic thoracic surgery in Turkey varies according to the type of operation, ranging between three thousand and ten thousand US dollars.

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