Background and Objectives: Insufficient margin in lung cancer is associated with an increased locoregional recurrence rate. In pulmonary segmentectomy, two commonly used methods for identifying the intersegmental plane are inflation–deflation and indocyanine green dyeing. The aim of this study was to compare these two methods in terms of quality margins and to evaluate their superiority. Materials and Methods: A total of 63 patients who underwent segmentectomy via video-assisted thoracoscopic surgery (VATS) for pulmonary nodules and underwent preoperative planning with 3D modeling between October 2020 and February 2024 were included in this study. The location of the nodule and the distance to the intersegmental margins were virtually measured preoperatively using an open-source 3D modeling system. Patients were grouped according to the method of identifying the intersegmental margins. Group 1 included segmentectomies performed by the inflation–deflation method (n = 42), and Group 2 included segmentectomies performed by systemic indocyanine green (ICG) injection (n = 21). The area where the histopathological nodule was measured closest to the intersegmental margin was recorded. Values within (+/−10 mm) compared to the value measured in the three-dimensional model were considered successful. The obtained data were statistically compared between the groups. Results: There was no difference between the groups in terms of virtual and pathological margins. However, in terms of margin quality, the rate of deviation detected in the pathological margin compared to the measured virtual margin was significantly different between the groups (p = 0.04). Accordingly, the success rate was 64.3% in Group 1 and 90.5% in Group 2 (p = 0.05). In Group 1, the failure rate was highly against the adjacent parenchyma. There was no significant difference between the groups in the analysis of simple and complex segmentectomies. Conclusions: Intersegmental plane identification with indocyanine green increases the margin quality by defining resection margins closer to the virtual margins. In the inflation–deflation method, unnecessary parenchymal loss occurs due to disadvantages in identifying intersegmental margins.

Background: The aim of this study was to evaluate the effects of preoperative three-dimensional (3D) modeling on the performance of uniportal video-assisted thoracoscopic bronchial sleeve resection and early postoperative outcomes. Methods: A total of 10 patients (5 males, 5 females; mean age: 53.8±16.9 years; range, 18 to 75 years) who underwent uniportal video-assisted thoracoscopic bronchial sleeve resection with preoperative 3D modeling between April 2021 and November 2023 were retrospectively analyzed. Preoperative 3D modeling was prepared using computed tomography with an open-source 3D software program. Demographic, clinical, intraoperative, and postoperative data of the patients were recorded. Anatomical landmarks identified by preoperative 3D modeling were compared with intraoperative findings. Results: The anatomical landmarks created with the 3D model were in 100% agreement with the intraoperative findings. The procedures performed were three left lower lobes, three right upper lobes, one middle lobe, one right lower lobe, and one parenchyma-sparing intermediate bronchial sleeve resection. Bronchial sleeve resection was completed using uniportal video-assisted thoracoscopic technique in 90% of patients, with only one patient requiring conversion to open thoracotomy. The mean resection time was 264.2±40.5 min, and the mean anastomosis time was 86.0±20.3 min. Anastomosis times decreased with increasing experience (p=0.008). Postoperative atelectasis was observed in two patients, and there was no mortality. The mean follow-up duration was 12.2±11.8 months. Conclusion: Preoperative 3D modeling significantly contributed to the successful implementation of uniportal video-assisted thoracoscopic bronchial sleeve resection surgery. In the future, with advancements in simulation programs, patient-specific 3D modeling is expected to benefit the identification of anatomical landmarks for bronchial sleeve resections.

Spontaneous pneumothorax (SP) is characterized by air accumulation between the visceral and parietal pleural layers without traumatic or iatrogenic causes. Although its etiology is not fully understood, risk factors include low body mass index, tall stature, smoking, and male sex. Alpha-1 antitrypsin deficiency (AATD), caused by SERPINA1 mutations, may contribute to secondary SP (SSP) through mechanisms such as alveolar destruction and emphysema development. This study aimed to determine the frequency and distribution of SERPINA1 gene mutations in individuals diagnosed with SP and to assess the distribution of these mutations according to pneumothorax type – primary SP (PSP) versus SSP. This cross-sectional descriptive study was conducted at the Pulmonology Clinic of Samsun Training and Research Hospital between January 1, 2022, and December 31, 2024. A total of 100 patients aged over 18 years who were diagnosed with SP and provided informed consent were included. Dried blood spot samples were collected for SERPINA1 genotyping (AlphaKits® GE Healthcare Ltd, Cardiff, UK), performed at the Progenika Clinical Diagnostics Laboratory (Spain). Demographic characteristics, smoking status, pneumothorax type, and thoracic CT findings were analyzed. One hundred patients (86% male) with a mean age of 38.8 ± 17.2 years were included. Sixty-six percent were smokers, 23% were nonsmokers, and 11% were ex-smokers. Among them, 55% had SSP and 45% had PSP. The underlying cause of SSP was emphysema in 43 patients (78.1%) and bronchiectasis in 12 patients (21.9%). SERPINA1 gene mutations associated with AATD were identified in 2 patients (2%), both in the SSP group. No mutations were detected in PSP cases. The genotype detected in both cases was PI*M/I, and both patients were smokers with emphysematous changes on thoracic CT. In conclusion, Screening strategies based solely on A1AT serum levels are insufficient as some carriers may have near-normal levels. However, routine genotyping of all SP patients is not supported by our data. Large prospective studies should clarify the role of targeted genetic testing in selected patient subgroups.

Aims: Thoracic anatomical variations and congenital anomalies are usually incidental findings on chest radiographs but may have important implications for diagnosis, interventional procedures, and surgical planning. Epidemiological data on their prevalence in large adult populations, particularly from Turkiye, remain limited. The aim of this study is to strengthen the epidemiological evidence regarding the adult population in Turkiye and to provide a reference dataset that is comparable with radiologic variation data reported in the international literature. Methods: In this retrospective cross-sectional study, digital posteroanterior chest radiographs of 34,445 adults. Thoracic anatomical variations and congenital anomalies detectable on chest radiographs (azygos lobe, right aortic arch, hiatal hernia, Chilaiditi sign, situs inversus totalis, and cervical rib) were systematically evaluated by two pulmonology specialists using Picture Archiving and Communication System (PACS). Results: Thoracic anatomical variations and congenital anomalies were identified in 423 of 34,445 patients (1.2%). The most common finding was an azygos lobe (0.9%), followed by hiatal hernia (0.2%), while right aortic arch, cervical rib, Chilaiditi sign, and situs inversus totalis were rare. Azygos lobe was significantly more frequent in males, whereas hiatal hernia and cervical rib were significantly more frequent in females (p

Isolated sternal fractures are rare pathologies that rarely require surgical fixation. Although different fixation techniques are used, it is routinely performed under general anaesthesia. In our study, we aimed to share the details of the awake sternal fixation technique performed in our clinic and to compare the early results with sternal fixation methods performed under general anaesthesia. Between January 2009 and January 2023, 129 patients who were diagnosed with sternal fracture and who underwent investigations and follow-up in our clinic were evaluated retrospectively. Thirteen patients who underwent surgical fixation for isolated sternal fracture were included in the study. Patients were categorized according to fixation and anaesthetic technique; group 1: fixation with steel wire under general anaesthesia (n = 4), group 2: fixation with titanium plate–screw under general anaesthesia (n = 4) and group 3: fixation with awake titanium plate–screw with parasternal intercostal plane block (n = 5). Demographics, surgical indication, radiological findings, surgical incision, surgical time and hospital stay were statistically compared. The mean age of the patients included in the study was 55.15 ± 15.01 years and 84.6% (n = 11) were male. The most common reason for fixation was displaced fracture (53.8%). Fixation surgery was performed due to pain in 30.8% (n = 4) and non-union in 15.4% (n = 2) of the fractures. The mean duration of surgery were 98.75 ± 16.52, 77.5 ± 35 and 41 ± 14.74 min, respectively. Duration of surgery was significantly lower in group 3 compared to the other groups (P = 0.012). The hospital stay duration for group 1 was 6 days, group 2 was 4 days and group 3 was 1 day. A notable difference was observed among all groups (P = 0.019). Awake sternal fixation technique with titanium plate–screw system under superficial parasternal intercostal plane block is an easy and effective method for surgical treatment of isolated sternal fractures. This technique showed a direct positive effect on the duration of surgery and hospital stay.