Toraks Kesileri
Özet
Toraks kesileri, göğüs cerrahisinin tarihsel gelişimi boyunca anestezi ve ventilasyon tekniklerindeki ilerlemelere paralel olarak çeşitlilik göstermiştir. Cerrahi müdahalenin başarısı; operasyon için uygun görüş alanı sağlaması, göğüs duvarı işlevini koruması ve postoperatif komplikasyon ile ağrıyı minimize etmesiyle doğrudan ilişkilidir. Açık göğüs cerrahisinde en sık başvurulan yöntem olan torakotomi, kaburgalar arasından yapılan kesileri ifade eder ve başlıca anterolateral ile posterolateral olmak üzere ikiye ayrılır. Uzun yıllar standart olarak kullanılan posterolateral torakotomi geniş bir görüş alanı sunsa da, ameliyat sonrasında şiddetli ağrı, omuz hareketlerinde kısıtlılık ve zayıf kozmetik sonuçlar gibi dezavantajlara sahiptir. Bu olumsuzlukları azaltmak amacıyla latissimus dorsi ve serratus anterior kaslarının korunduğu kas koruyucu torakotomiler geliştirilmiştir. Bunun yanı sıra, kardiyak girişimler ve mediastinal tümör cerrahisinde yaygın olarak kullanılan medyan sternotomi, sternumun dikey olarak kesilmesini içerir ve postoperatif ağrısı daha az olan bir yöntemdir. Günümüzde minimal invazif cerrahi yöntemlerin (VATS ve robotik cerrahi) ve subksifoid yaklaşımların yaygınlaşması, büyük torakotomi kesilerine olan ihtiyacı azaltarak hastaların iyileşme süreçlerini hızlandırmış ve ameliyat sonrası konforu artırmıştır.
Thoracic incisions have diversified throughout the historical development of thoracic surgery, parallel to advancements in anesthesia and ventilation techniques. The success of a surgical intervention is directly related to providing an adequate operative field, preserving chest wall function, and minimizing postoperative complications and pain. Thoracotomy, the most common method in open chest surgery, refers to incisions made between the ribs and is mainly divided into anterolateral and posterolateral approaches. Although posterolateral thoracotomy, used as a standard for many years, offers a wide field of view, it has disadvantages such as severe postoperative pain, limitation in shoulder movements, and poor cosmetic outcomes. To mitigate these drawbacks, muscle-sparing thoracotomies have been developed, preserving the latissimus dorsi and serratus anterior muscles. Additionally, median sternotomy, widely used in cardiac interventions and mediastinal tumor surgery, involves a vertical division of the sternum and is associated with less postoperative pain. Today, the widespread adoption of minimally invasive surgical methods (VATS and robotic surgery) and subxiphoid approaches has reduced the need for large thoracotomy incisions, thereby accelerating patient recovery processes and enhancing postoperative comfort.
Referanslar
Miller JI, Jr. The history of surgery of empyema, thoracoplasty, Eloesser flap, and muscle flap transposition. Chest Surg Clin N Am 2000; 10: 45–53.
Todd TR. The history of ventilation in the evolution of thoracic surgery. Chest Surg Clin N Am.2000; 10: 71–82.
Hagopian EJ, Mann C, Galibert LA, Steichen FM. The history of thoracic surgical instruments and instrumentation. Chest Surg Clin N Am 2000;10: 9–43.
Karmakar MK, Ho AM. Postthoracotomy pain syndrome. Thorac Surg Clin 2004; 14: 345–352.
Mushin WW, Rendell-Baker L, Thompson PW, Mapleson WW. Automatic ventilation of the lungs. Oxford: Blackwell Scientific; 1980: 887-887
Li WW, Lee TW, Yim AP. Shoulder function after thoracic surgery. Thorac Surg Clin 2004; 14: 331–343.
Berry MF, Friedberg J. Chest wall/diaphragmatic complications. Thorac Surg Clin 2006; 16: 277–285.
Heitmiller RF. Thoracic incisions. Baue AE, Geha AS, Hammond GL et al. eds. Glenn’s Thoracic and Cardiovascular Surgery, 6th edn. Appleton and Lange, Stamford, CT, 1996:73–89.
Detterbeck FC. Efficacy of methods of intercostal nerve blockade for pain relief after thoracotomy. Ann Thorac Surg 2005; 80: 1550–1559.
Fry WA, Kehoe TJ, McGee JP. Axillary thoracotomy. Am Surg 1990; 56: 460–462.
McNeill TM, Chamberlain JM. Diagnostic anterior mediastinotomy. Ann Thorac Surg. 1966;2(4):532-9.
Murthy S. Thoracic incisions. In: Patterson GA, Cooper J, Deslauriers J, Lerut A, Luketich J, Rice T, editors. Pearson’s Thoracic and Esophageal Sugery. 3rd ed. Oxford, UK: Churchill Livingstone; 2008;p.122–3.
Shaw RR, Paulson DL, Kee JL. Treatment of Superior Sulcus Tumor by Irradiation Followed by Resection. Ann Surg. 1961;154(1):29-40.
Milton H. Mediastinal surgery. Lancet 1897; 1: 872.
Julıan O, Lopez-Belıo M, Dye W, Javıd H, Grove W. The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery. Surgery 1957; 42: 753-61.
LoCicero III J. Sternotomy and thoracotomy for mediastinal disease. In Shields TW, LoCicero III J, Ponn RB, Rusch VW, ed. General Thoracic Surgery, vol 2, 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2005; 2449-52.
Demmy TL, Park SB, Liebler GA, Burkholder JA, Maher TD, Benckart DH, Magovern GJ Jr, Magovern, GJ Sr, Recent experience with major sternal wound complications. Ann Thorac Surg 1990;49:458-462.
Fry WA. Thoracic Incisions. In Shields TW, LoCicero III J, Ponn RB, Rusch VW, ed. General Thoracic Surgery, vol 1, 6th ed.Philadelphia: Lippincott Williams and Wilkins; 2005: 411-9.
Zwart H. Partial sternotomy: a mini approach for maxi exposure. J Thorac Cardiovasc Surg 1997; 114: 686.
Moreno-Cabral RJ. Mini-T sternotomy for cardiac operations. J Thorac Cardiovasc Surg 1997; 113: 810–811.
Gillinov AM, Banbury MK, Cosgrove DM. Hemisternotomy approach for aortic andmitral valve surgery. J Card Surg. 2000 Jan-Feb;15(1):15-20.
Enön S, Torasik insizyonlar. In Ökten İ, Güngör A. Göğüs Cerrahisi, Cilt-I. 2003: 463-82.
Dartevelle PG, Chapelier AR, Macchiarini P. Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet. J Thorac Cardiovasc Surg 1993;105:1025-34. 27. Lucà F, van Garsse L, Rao.c
Carvalheiro C, Gallego-Poveda J, Gonzalez-Rivas D, Cruz J. Uniportal VATS Lobectomy: Subxiphoid Approach. Rev Port Cir Cardiotorac Vasc. 2017Jul-Dec;24(3-4):141.
Chiu CH, Chao YK, Liu YH. Subxiphoid approach for video-assisted thoracoscopic surgery: an update. J Thorac Dis. 2018 Jun;10(Suppl14):S1662-65.
