Introduction

Abstract

This issue of Operative Techniques is devoted to advances in minimally invasive resections for lung and esophageal cancer. Video-assisted thoracic surgery (VATS) lobectomy is a common procedure and has become the standard of care for early-stage lung cancer in most practices. The group from Roswell Park, led by Dr Todd Demmy, has advocated that in select patients a VATS pneumonectomy can be performed safely and with good oncologic outcomes. This group describes their approach to a VATS left pneumonectomy. Most of the technical aspects of the procedure are common to experienced VATS surgeons, but several of the described exposure maneuvers are very helpful, particularly related to dissection and isolation of the pulmonary artery from the mainstem bronchus. In the companion article, Dr David R. Jones from Memorial Sloan-Kettering Cancer Center describes his approach to performing a minimally invasive Ivor-Lewis esophagectomy. To enhance the quality of the article, the illustrations are color intraoperative still shots. This procedure requires advanced laparoscopic as well as VATS techniques to perform. As with any esophageal resection, creation of a tension-free and well-vascularized anastomosis is critical to the success of the procedure. The side-to-side anastomosis as described in this procedure works well and is easily reproducible and can be taught to residents and other thoracic surgeons new to the procedure. Collectively, these articles provide the reader with a solid technical description of 2 advanced minimally invasive resection procedures. The Adult Cardiac section addresses the implantation of “sutureless” aortic prostheses. Suri et al, describe the techniques for the open implantation of the currently available sutureless aortic valve prostheses. Patient selection and the operative steps are nicely detailed. Davidson et al, present a description of transaortic implantation of transcatheter aortic valves in patients in whom transfemoral access is unavailable. The incisional options and the technical details of sheath placement and valve deployment are well described. The methods presented in these 2 papers add to the ever-growing armamentarium of options that are being developed for replacing the diseased aortic valve in patients who may not be candidates for conventional aortic valve surgery. In a significant number of patients, the initial repair of tetralogy of Fallot includes transannular patch augmentation of the right ventricular outflow tract. This technique leads to chronic pulmonary regurgitation. In a significant number of postoperative patients, there are long-term complications of pulmonary regurgitation including right ventricular dilation and dysfunction, atrial and ventricular arrhythmias, and exercise intolerance. Pulmonary valve insertion is often required in these patients. In recent years, there has been increasing interest in techniques to preserve pulmonary valve structure and function at the initial operation to avoid these long-term sequelae. In the current issue, Drs Bacha and Mavroudis provide detailed technical descriptions of their valve-sparing techniques for tetralogy of Fallot repair. These outstanding papers discuss patient selection, intraoperative assessment of the right ventricular outflow tract, and a variety of useful strategies to achieve relief of outflow tract obstruction while preserving valve function.