Akademik Veri Yönetim Sistemi
Pleural Diseases: Anatomy, Physiology, and Pathophysiology, Güntuğ Batıhan, Editör, IntechOpen, London, ss.1-10, 2025
Pleural decortication is a fundamental operation for restoring lung expansion in organized pleural disease. Over the last two decades, video-assisted thoracoscopic surgery (VATS) has evolved from a drainage-and-debridement tool to a definitive decortication approach for selected patients with organized empyema, retained hemothorax, and trapped lung from chronic pleuritis or hemothorax. Compared with open thoracotomy, VATS decortication is associated with less postoperative pain, shorter length of stay, and faster recovery, while maintaining comparable success rates when complete parietal and visceral pleural peel removal can be achieved. Patient selection, stage-based timing, and meticulous subpleural plane dissection are the cornerstones of efficacy. This chapter outlines indications, work-up, anesthesia and positioning, step-by-step VATS technique (multiport and uniportal), decision thresholds for conversion, management of complex scenarios (tuberculous and fungal empyema, postlobectomy space, bronchopleural fistula, retained hemothorax, pediatric cases), postoperative care (including digital drain strategies), complication avoidance and management (persistent air leak, bleeding, reexpansion pulmonary edema), and expected outcomes. We also summarize the current evidence base and practical algorithms to guide adoption in low- and high-volume centers, and highlight future directions, including robotic assistance, image-guided dissection, and data-driven drain management.