Development Of Video-assisted Thoracic Surgery Research Articles

Does aggressive management ofsolitary pulmonary nodulespay off?

Indeterminate solitary pulmonary nodules (SPNs), measuring up to 3 cm in diameter, are incidental radiological findings. The ever-growing use of modern imaging has increased their detection. The majority of those nodules are benign; however, the possibility of diagnosing early-stage lung cancer still stands. Guidelines for the management of SPNs have never been validated in prospective comparative studies.Positron emission tomography (PET) is a useful tool to provide functional information on SPNs. However, overall sensitivity and specificity of PET in detecting malignant SPNs of at least 10 mm in diameter are about 90% and false-negative results are reported.The development of video-assisted thoracic surgery has provided minimally invasive diagnosis and treatment of SPNs. In our series, 105 patients underwent surgery based on combined increased 18F-labelled 2-fluoro-2-deoxy-d-glucose (FDG) uptake on PET computed tomography and radiological features (morphology and density) without prior histological confirmation. We detected 26 false negatives (24.8%) and only nine false positives (8.57%). Therefore, our minimally invasive surgical approach prevented 25% of patients with lung cancer from a delayed treatment versus only 9% undergoing “overtreatment”.In our monocentric cohort, patients with SPNs with large diameter, irregular outline, no calcifications, central location, increased FDG uptake and/or subsolid aspect benefited from a primary surgical resection.

Video-Assisted Thoracic Surgery and Anatomical Lung Resections. Where Do We Stand? National Survey by the Spanish Society of Thoracic Surgery

IntroductionThe objective of this survey is to find out the cumulated experience and the current situation of video-assisted thoracic surgery (VATS) for anatomical lung resections in Spain. MethodsThis is a descriptive study performed from two independent surveys designed through the Survey Monkey® web platform. The first survey was aimed at 53 thoracic surgery departments from the public and state-assisted national health system. The second survey, of a personal nature, was directed at 315 thoracic surgeons in active service, including physicians at their residency program. The surveys were kept operative from 18/11/2014 to 15/01/2015. ResultsThe first survey was answered by 32 (60%) departments and the second by 167 (53%) professionals. A total of 29 (91%) of the thoracic surgery departments represented recognized having some level of experience in this technique. However, a great proportion of departments, 15 (52%), counted less than 100 procedures and the cumulated time of experience was lower than 5 years in 19 (66%) departments. Among all the individual respondents, 126 (77%) admitted having performed the procedure at some point. Of those without any experience, at least 36 (95%) of them recognized that future training in this technique is one of their future professional objectives. ConclusionsWaiting for future prospective national registries contribute further information about the expansion of this technique in our country, the results of the current survey show, up to now, the best reflection of clinical practice and opinion of the surgeons involved in the development of VATS.

Cirugía torácica video-asistida y resecciones pulmonares anatómicas. ¿Dónde estamos? Encuesta nacional de la Sociedad Española de Cirugía Torácica

IntroductionThe objective of this survey is to find out the cumulated experience and the current situation of video-assisted thoracic surgery (VATS) for anatomical lung resections in Spain. MethodsThis is a descriptive study performed from two independent surveys designed through the Survey Monkey® web platform. The first survey was aimed at 53 thoracic surgery departments from the public and state-assisted national health system. The second survey, of a personal nature, was directed at 315 thoracic surgeons in active service, including physicians at their residency program. The surveys were kept operative from 18/11/2014 to 15/01/2015. ResultsThe first survey was answered by 32 (60%) departments and the second by 167 (53%) professionals. A total of 29 (91%) of the thoracic surgery departments represented recognized having some level of experience in this technique. However, a great proportion of departments, 15 (52%), counted less than 100 procedures and the cumulated time of experience was lower than 5 years in 19 (66%) departments. Among all the individual respondents, 126 (77%) admitted having performed the procedure at some point. Of those without any experience, at least 36 (95%) of them recognized that future training in this technique is one of their future professional objectives. ConclusionsWaiting for future prospective national registries contribute further information about the expansion of this technique in our country, the results of the current survey show, up to now, the best reflection of clinical practice and opinion of the surgeons involved in the development of VATS.

Low-cost biportal endoscopic surgery for primary spontaneous pneumothorax.

Like many other countries, including the United States, China faces the problem of rising health care costs, which have become a heavy burden on the state and individuals. Endoscopic surgery offers many benefits. However, the need for more expensive endoscopic consumables brings further high medical costs. Therefore, the development of video-assisted thoracic surgery with no disposable consumables will help to control medical cost escalation. Between October 2011 and September 2014, a series of 66 patients with primary spontaneous pneumothorax underwent hand ligation of blebs under biportal video-assisted thoracoscopic surgery or bullectomy with stapler during triportal video-assisted thoracoscopic surgery. After treatment of blebs, pleural abrasion was performed with an electrocautery cleaning pad. Compared with the group treated by bullectomy with stapler, we found a significant reduction in postoperative costs in the group with bleb ligation. There was no difference in operating time, chest tube drainage, and postoperative stay between the two groups. The follow-up period varied from 1 to 35 months and six cases of recurrence were noted. The technique that we described appears to offer better economic results than bullectomy with a stapler under three-port video-assisted thoracoscopic surgery for treating primary spontaneous. The clinical outcomes are similar.

Radical treatment for left upper-lobe cancer via complete VATS.

Along with the development of video-assisted thoracic surgery (VATS), its role in radical treatment is basically the same as the conventional open surgery. Meanwhile, as a minimally invasive technique, it can achieve quick recovery. Nowadays the value of VATS has been globally recognized, and its indications have been further expanded. The common procedures of VATS lobectomy include anatomic lobectomy, single-direction lobectomy, simultaneous stapling, and retrograde lobectomy. Retrograde lobectomy is particularly useful for patients who are not feasible for anatomic lobectomy due to the swollen lymph nodes at the hilum of lung or because the tumors have invaded the pulmonary artery. This article describes a 60-year-old female patient with left upper lobe carcinoma who underwent complete VATS retrograde lobectomy due to swollen lymph nodes at the hilum of lung. Chest CT indicated a shadow at the left upper pulmonary lobe, along with swollen lymph nodes at the hilum of lung. The mass invaded the first branch of the pulmonary artery. Retrograde lobectomy was then performed. The postoperative recovery was good. Pathology showed an invasive adenocarcinoma at the left upper lung, along with lymph node metastases at the hilum of lung and mediastinum. No cancer was found at the bronchial stumps and vascular stumps. Complete VATS retrograde lobectomy is safe and feasible for patients with swollen lymph nodes at the hilum of lung.

Cirugía torácica videoasistida, trasplante pulmonar y mediastinitis, temas destacados de cirugía torácica en 2010

We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. To do this, the 43 rd Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña and the articles published in the Society's journal, archivos de bronconeumología, were reviewed. The main areas of interest were related to the development of video-assisted thoracic surgery, lung transplantation and descending mediastinitis. The new tumor-node-metastasis (TNM) classification (7 th edition), presented last year, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in Thoracic Surgery together with the Nurses’ Area have constituted an excellent teaching program.

Voies d'abord chirurgicales antérieures du thorax

Anterior surgical approaches of the chest are mainly used for cardiac surgery with cardiopulmonary bypass, mediastinal surgery, and lung and heart-lung transplantation. For years, posterolateral thoracotomy has been considered as the approach of choice to deal with pulmonary resection, while bilateral anterior thoracotomies with transverse sternotomy (clamshell incision) was historically the approach for cardiac surgery. Around 1957, clamshell incision was replaced by median sternotomy popularised by Julian. Development of video-assisted thoracic surgery around 1990 allowed to review surgical approaches, so minimal access with minor parietal injuries gain success. However, in the same period, clamshell approach was reintroduced by Cooper et al 1990 to facilitate access for double lung transplantation. In this article, the authors present different aspects of anterior surgical approaches of the chest : median sternotomy, anterolateral thoracotomy, anterior mediastinotomy, transsternal bilateral thoracotomy (clamshell incision), sternotomy and lateral thoracotomy (hemi-clampshell incision). Technical aspects in detail as well as indications, pitfalls, and complications are described through a strikingly illustrated text.

Thoracoscopy in Horses

With the recent development of video-assisted thoracic surgery, visual inspection of the thoracic cavity has been used to provide a more accurate diagnosis and prognosis of thoracic diseases and to better manage these diseases. Equipment, techniques, and complications for standing thoracoscopy in horses are described.

Initial experience with video-assisted thoracoscopic lobectomy

In the past 2 years, the development of video-assisted thoracic surgery (VATS) has allowed thoracoscopy to rapidly evolve from a primarily diagnostic tool to a therapeutic tool with potentially useful applications. As with laparoscopy, the initial enthusiasm for VATS must be tempered by the reality of technical inadequacies, complications, and results that have yet to withstand careful scientific scrutiny. The purpose of this study was to determine the technical feasibility of a VATS lobectomy. Forty-four patients with primary bronchogenic carcinoma were evaluated and accepted as potential candidates for VATS lobectomy. After complete preopetative staging, these patients were in clinical stage I. All patients had normal arterial blood gases and adequate pulmonary function (forced expiratory volume in 1 second > 1.5 L) to tolerate a lobectomy. At the time of operation, 3 patients were found to have N2 disease and were excluded from the study. In 35 of the remaining 41 patients, a successful VATS lobectomy was accomplished through two thoracoscopy ports and a non-rib-spreading 6- to 8-cm “access” thoracotomy. There were no major intraoperative complications that necessitated conversion to an open thoracotomy. Mean operative time was 153 ± 26 minutes. All 35 patients recovered uneventfully with a mean hospital stay of 5.7 ± 1.6 days. A VATS lobectomy is technically feasible using our approach and is potentially safe. However, major advances in thoracoscopic imaging and instrumentation are necessary before this procedure will have the potential for widespread acceptance. Also, the advantages of VATS lobectomy over accepted surgical techniques will have to be carefully documented in randomized trials.