Field Of Thoracic Surgery Research Articles

Verletzungen des Tracheobronchialbaums

Tracheobronchial injuries are rare events but often life-threatening. A great expertise in the field of thoracic surgery is necessary to manage these events. The aetiology of the injury - traumatic or iatrogenic - allows immediate considerations about the pattern of damage. The flexible or rigid bronchoscopy is the central diagnostic procedure to classify the injury. Whereas iatrogenic tracheal lacerations can be treated by conservative or operative means depending on severity, traumatic injuries of the tracheo-bronchial system need technically challenging operative reconstructions in almost every case.

Transumbilical thoracic sympathectomy with an ultrathin flexible endoscope in a series of 38 patients

The newest trend in the field of thoracic surgery, thoracic natural orifice transluminal endoscopic surgery (NOTES), is still in the early stages of development and limited to animal experiments. Transumbilical endoscopic surgery could work as a viable intermediate step before pure NOTES. We describe our experiences performing transumbilical-diaphragmatic thoracic sympathectomy with an ultrathin flexible endoscope for palmar and axillary hyperhidrosis in human patients. From April 2010 to January 2012, a total of 38 patients underwent transumbilical-diaphragmatic thoracic sympathectomy. Through the incision in the umbilicus, a newly developed long trocar was inserted into the abdominal cavity. An ultrathin endoscope was introduced through the long trocar and then passed through the rigid incision made in the left and right diaphragm and into the thoracic cavity. The ganglion was ablated at the desired thoracic level. Sympathectomy was performed successfully in all patients. Mean operation time was 68 ± 16 (range, 48-107) minutes. There was no mortality and no conversion to open surgery during the operation of any patient. At a median follow-up of 11 (range, 4-12) months after surgery, no diaphragmatic hernia was observed. The rate of palmar hyperhidrosis and axillary hyperhidrosis resolution was 100 and 75 %, respectively. Transumbilical endoscopic thoracic sympathectomy is technically feasible and safe, which has the possible advantages of pure NOTES and can be performed in routine clinical practice.

Robot-assisted thoracoscopic surgery: current status and prospects

The most favorable advantage of robotic surgery is the markedly free movement of joint-equipped robotic forceps under 3-dimensional high-vision. Accurate operation makes complex procedures straightforward, and may overcome weak points of the previous thoracoscopic surgery. The efficiency and safety improves with acquiring skills. However, the spread of robotic surgery in the general thoracic surgery field has been delayed compared to those in other fields. The surgical indications include primary lung cancer, thymic diseases, and mediastinal tumors, but it is unclear whether the technical advantages felt by operators are directly connected to merits for patients. Moreover, problems concerning the cost and education have not been solved. Although evidence is insufficient for robotic thoracic surgery, it may be an extension of thoracoscopic surgery, and reports showing its usefulness for primary lung cancer, myasthenia gravis, and thymoma have been accumulating. Advancing robot technology has a possibility to markedly change general thoracic surgery.

Surgery of Pulmonary Metastases: Series of 85 Patients

Introduction: Lung metastases are the second leading cause of lung resection, constituting 30-40% of all surgeries performed in the field of Thoracic Surgery. Resection of pulmonary metastases is an open issue that generates various controversies. Depending on the functional respiratory capacity of the pulmonary metastatic patient, may come to consider multiple surgeries in the same patient, as many as the patient is able to tolerate by his or her respiratory reserve. Goal: Study of the results from surgical resection of pulmonary metastases in general and in particular those of colorectal origin. Patients and methods: Descriptive and observational retrospective study of 85 patients with pulmonary metastases who underwent surgery at our centre from January 2003 to December 2007. Results: Surgery was performed in 85 patients, 56 males (66%) and 29 women (34%) with a mean age of 55.14 years (range 22-82 years). The PMCRC (Pulmonary Metastases from Colorectal Cancer) correspond to 30 patients, meaning a 35% of all resected metastases. Next in frequency were the lung metastases of osteosarcoma, 16 (19%). And really close, metastases of soft tissue sarcoma, 11 (13%). The average overall survival from PM (Pulmonary Metastases) of colorectal origin was 36.64 months (range 18.58 to 54.70 months). If we break down the overall survival at one and three years, we get a probability of survival of 96% compared to 62%. Conclusions: Although surgery cannot change the biological essence of the metastatic process, complete resection of pulmonary metastases in appropriated selected patients, can provide a significant increase in survival or even a complete and permanent remission of the tumor.

From Jacobeaus to the Da Vinci

With the increasing recognition of the benefits of minimally invasive surgery, surgical technology has evolved significantly since Jacobeaus' first attempt at thoracoscopy 100 years ago. Currently, video-assisted thoracic surgery occupies a significant role in the diagnosis and treatment of benign and malignant diseases of the chest. However, the clinical application of video-assisted thoracic surgery is limited by the technical shortcomings of the approach. Although the da Vinci system (Intuitive Surgical) is not the first robotic surgical system, it has been the most successful and widely applicable. After early applications in general and urologic surgery, the da Vinci robot extended its arms into the field of thoracic surgery, broadening the applicability of minimally invasive thoracic surgery. We review the available literature on robot-assisted thoracic surgery in attempt to better define the current role of the robot in pulmonary, mediastinal, and esophageal surgeries.

The Clinical Application of Video Mediastinoscopy and CT in the N Staging of Preoperative Lung Cancer.

Preoperative lung cancer with mediastinal lymph nodes metastasis can be diagnosed by vedio mediastinoscopy (VM) and CT. This study was to explore the value of VM and CT in the diagnosis of N staging of preoperative lung cancer, and to discuss the difference between the two methods. Forty-eight cases diagnosed of lung cancer by CT or PET-CT were examined by VM. The sensitivity, specificity, validity, positive predictive value and negative predictive value of VM and CT were speculated according to the postoperative pathological reports, and the difference between VM and CT in the diagnosis of lung cancer with mediastinal lymph nodes metastasis was discussed. (1)Under the examination of VM, 31 patients with the negative outcome received the direct operation; 14 patients with N2 received 2 courses of neoadjuvant chemotherapy before operation; 3 patients with N3 received chemotherapy and/or radiotherapy. (2)Forty-one cases with final diagnosis of lung cancer were used as samples to speculate the sensitivity, specificity, validity, positive predictive value and negative predictive value of VM. They were 93.3%, 100%, 97.6%, 100%, 96.3%, which of CT were 66.7%, 53.8%, 58.5%, 45.5%, 73.7% (Chi-square=4.083, P=0.039), the difference between VM and CT was statistically significant. (3)In this group, the complications of VM incidence rate was 2.08% (1/48), and the case was pneumothorax. VM is superior to CT in the diagnosis of N staging of preoperative lung cancer; Due to its safety and effectiveness, VM will be wildly used in the field of thoracic surgery.

Omentoplasty in thoracic surgery

Plombage methods were designed for treating pulmonary tuberculosis surgically around 1945 when pulmonary tuberculosis was regarded as a "traitor disease" in Japan. Nagaishi had reported extrapleural synthetic resin ball plombage in 1948 as the world's first case, but it was complicated by empyema due to perforation of cavities and rupture of lesions because the resin ball was hard. Later, fillers were improved by using soft material. At the present time, only air plombage and omentoplasty remain. Especially the latter has gained widespread use in the thoracic surgery field and become a standard procedure. Chronic empyema with bronchopleural fistula sometime requires surgical treatment despite the development of various antibiotics, but highly stressful surgery that can cause reduced pulmonary function or thoracic deformity must be avoided. Therefore, one-stage omentoplasty utilizing such omental multi-functions as hose action, angiogenesis, sucker action, and the immune reaction has been found to have clinical significance for thoracic empyema and its complications. This method is described in detail.

Effects and risks of radiofrequency ablation on the pulmonary tissue and vascular system: A preliminary histological study

Radiofrequency ablation (RFA) is one of the minimally invasive therapeutic modalities for malignant tumors. However, the effects and risks associated with RFA on pulmonary tumors have not yet been well investigated. We pathologically examined the effects of RFA on the healthy pulmonary parenchyma in the inflated and deflated states of swine lungs. We used two 2-year-old female pigs. Under general anesthesia, RFA was performed twice. The mean duration of cauterization for the inflated lungs (93.0 +/- 65.4 s) was significantly shorter than that for the deflated lungs (390.3 +/- 75.6 seconds) (P = 0.0062). Histologically, the dilatation and congestion of the microvessels were more marked in the lungs. However, no histopathological differences were noticed between the inflated and deflated lungs. Adventitial degeneration was seen in the small vessels, but not in the wall of the large vessels. This study confirmed, pathologically, that RFA is effective with an acceptable degree of minimal damage to the normal lung tissue, irrespective of its conditions, i.e., inflated or deflated, and can be safely done near the pulmonary vessels. Therefore, RFA appears to be a promising therapeutic strategy to control local lesions in the field of thoracic surgery.

Toxic Shock Syndrome Following Thoracic Surgery for Lung Cancer: Report of a Case

Postoperative toxic shock syndrome (PTSS) caused by toxin-producing Staphylococcus aureus has incidentally been reported to be experienced following various surgical procedures or wounds. This syndrome includes sudden high fever, headache, muscle ache, a sunburn-like rash, hypotension, and tachycardia, while also often showing a rapid progression and a fatal outcome. To date, no such cases have ever been reported after thoracic surgery. We herein describe a highly probable case of PTSS in a 61-year-old man who underwent a pulmonary resection for lung cancer. The patient recovered after immediate and intensive antibiotic and steroid therapies. PTSS can occur incidentally even in the field of thoracic surgery; therefore, thoracic surgeons should be aware of this possible onset in order to recognize and treat this disease in a timely manner.

Sabiston & Spencer Surgery of the Chest, 7th ed, 2 Vols

Sellke and coauthors take on the formidable task of updating one the most respected texts in the field of thoracic surgery. They break away from the previous mold and in essence rewrite Surgery of the Chest with many new authors and chapters. The format aims to more accurately reflect today's practice patterns while maintaining the necessary background information expected in a reference text. New topics include catheter-based therapy, cardiac electrophysiology, multimodality therapy for thoracic malignancies, and cell-based treatments. Chapters devoted to the thoracic basic sciences have also been expanded. Retained are the sections of thoracic, adult cardiac, and congenital heart surgery. It thus remains one of the few all-inclusive textbooks in the field. Covered in each chapter are the background, pathophysiology, patient evaluation, treatment options, and outcomes for the various disorders. Surgery of the Chest continues to be an invaluable resource for thoracic residents as well as practicing general and thoracic surgeons. Its pricing is appropriate for the volume of material covered. The 7th edition is a significant update from the earlier versions and warrants perusal even by existing owners.

Ernst Trier Mørch: inventor, medical pioneer, heroic freedom fighter.

Ernst Trier Mørch: inventor, medical pioneer, heroic freedom fighter.

内視鏡下手術 食道疾患への応用と次世紀における展開

Endoscopic surgery has become widespread and is currently used in a wide range of general, thoracic, urologic, gynecologic and orthopedic procedures. In the field of thoracic surgery, a number of endoscopic surgical procedures have been recognized as standard for benign diseases, including spontaneous pneumothorax, esophageal submucosal tumors, giant esophageal diverticulum and gastroesophageal regurgitation. However, the indication of endoscopic procedures for malignant diseases in thoracic surgery is still under the evaluation. The balance between the operative radicality and the less invasive quality of these procedures should be evaluated in long-term observations.Although there are still many difficulties and limitations involved in endoscopic procedures, advanced technology is continually being introduced to overcome these problems. The introduction of three-dimensional video imaging, robotic surgery and advanced telecommunications will allow us to overcome many difficulties posed by the conventional endoscopic approach.

Surgery of the Chest

The first edition of Gibbons' Surgery of the Chest was published in 1962. Subsequent editions appeared at regular 7-year intervals until this most recent sixth edition edited by Drs Sabiston and Spencer, which was published only 5 years since the previous edition. The first edition of this monumental contribution to thoracic surgical literature had 32 chapters and 36 authors; the current edition contains 59 chapters (some amplified) written by 119 authors. Both the shortened interval between the 2 most recent editions and the increase in numbers of chapters and authors attest to the rapid and remarkable strides that have occurred in this field over the last 5 years. After an apparent stable plateau in the field of thoracic surgery, there seems to have been an increased rejuvenation of ideas involving newer and more sophisticated procedures, undoubtedly spurred on by rapid advances in technology. In this current edition of Surgery of

Morphologic alterations and cytokinetic studies of tracheal autograft epithelium in rabbits

Although tracheobronchoplasty has been used widely in the field of thoracic surgery, few details of the morphologic changes in and cytokinetics of the graft epithelium have been reported. The aim of this study was to focus on these aspects in autografted rabbit tracheas. Resected cervical tracheas were anastomosed immediately after removal, retrieved on postoperative days 1 through 28, and examined morphologically. Mitotic and bromodeoxyuridine-labeling indices of the graft epithelium were analyzed. On postoperative days 1 to 4, the graft epithelium showed focal desquamation at the anastomoses. Ciliated cells disappeared during postoperative days 4 to 7 and then increased gradually. Nonciliated cells retained a somewhat columnar shape on postoperative days 4 to 7, except at denuded foci. Thereafter, the grafts were covered completely with pseudostratified mucociliary epithelium. On postoperative day 4, both indices were maximal and appeared higher at the anastomotic than midgraft sites. Most of the graft epithelium was preserved during acute ischemia and then started to regenerate. The increased regenerative activity near the anastomoses may be attributable to mechanical damage or different nutritional conditions.

A simple technique for thoracoscopic resection of lung tumors.

Mainly incited by the bushfirelike spread of endoscopic operative techniques in general surgery, thoracoscopy has become the object of new interest in the field of thoracic surgery. Location and resection of lung tumors are problematic for several reasons and so far not standardized. The main problems are pointed out. A new technique together with the instruments and their advantages is demonstrated. Future aspects are discussed.

Formaldehyde-free collagen glue in experimental lung gluing

Because of the well-known limitations of the adhesive strength of fibrin glue, it is imperative to develop a stronger glue with acceptable bioccmpatibility. This was accomplished by removing the formaldehyde component from gelatin-tesoicinol-formaldehyde glue and replacing it by two less toxic aldehydes—pentanedial and ethanedial. To evaluate the adhesive strength of this new glue, GR-DIAL, lung incisions in rabbit hybrids were glued together. Each group (n = 5) was examined histologically after 2 days and 1, 2, and 4 weeks. The glue disintegrated gradually with good bioresorption when the incision was closed with a thin layer of glue. The healing process was favorable, indicating good biocompatibility. Therefore, GR-DIAL glue is capable of enhancing the use of surgical glues in the field of thoracic surgery by enabling surgeons to close larger parenchyma! lesions than with fibrin glue.

48] Application of immobilized enzymes for biomaterials used in surgery

This chapter discusses the application of immobilized enzymes for biomaterials used in surgery. The chapter investigates the replacement of various organs with this new material experimentally and clinically, including reconstruction of the trachea, chest wall, and diaphragm in the field of thoracic surgery. With the development of techniques for binding enzymes to insoluble supports, immobilized enzymes are recently utilized in various types of medical applications, especially in clinical analysis and also in therapeutic medicine. This collagen-synthetic polymer composite material is applied as a support for the immobilization of enzymes to establish its biological functions on the surface of the material, and enzymes are successfully bound to the collagen membrane layer by activation of carboxyl groups. Trypsin and urokinase are chosen with the intention of adding proteolytic (antiinflammatory) and fibrinolytic (thromboresistant) activities, respectively, to the surface properties of the composite material. Lysozyme and a peptide antibiotic, polymyxin B, are bound onto the material for the purpose of producing bacteriolytic and antibacterial biomaterials to prevent serious problems caused by bacterial infection from occurring when artificial organs and biomaterials are implanted into the body. The chapter describes the novel method of producing this enzyme-bound collagen-synthetic polymer composite material, and discusses the enzymatic characterization and several in vivo experiments made with the material carrying immobilized enzymes.

Single-Stage Complete Muscle Flap Closure of the Postpneumonectomy Empyema Space: A New Method and Possible Solution to a Disturbing Complication

The management of postpneumonectomy empyema remains a disturbing and controversial area in the field of thoracic surgery. Many methods have been described and have had varying degrees of success. We present a series of 5 consecutive patients who underwent single-stage complete muscle flap closure of the pneumonectomy space with extrathoracic muscle flaps and omental grafts between October, 1981, and April, 1983. Two men and three women ranging from 37 years to 64 years old underwent such a closure from 3 to 13 months after original resection. Two patients had associated bronchopleural fistula. Prior to closure, 3 patients were managed with chest tubes and 2 with a modified Eloesser procedure. All operations were single-stage procedures, and all wounds closed primarily, with no permanent tubes or chest wall openings. There was no morbidity or mortality, and no subsequent operation has been required. Single-stage complete muscle flap closure of the postpneumonectomy empyema space has not been described previously, and we think it offers a possible solution to this potentially fatal complication.

Surgery of the esophagus.

NO previous Medical Progress report has been limited exclusively to surgery of the esophagus. The topic was included most recently in a review of the broad field of thoracic surgery by Scannell and...

Surgical Diseases of the Chest

Foundations of Thoracic Surgery , by F. Ronald Edwards, 180 pp, with illus, $10.25, Edinburgh and London: E. & S. Livingstone, Ltd. (Baltimore: Williams & Wilkins Co.), 1966. The second edition of Dr. Blades' excellent textbook on thoracic surgery is indeed welcome. It consists of multiple contributions from 20 separate authors, each of whom is a highly recognized authority in his field. The new edition not only brings matters up to date in each individual field but places particular emphasis on the recent developments in cardiovascular surgery. There is an entire new chapter describing the recent developments relative to coronary cineangiography and the surgical treatment of coronary heart disease. Detailed descriptions relative to operative procedures are given mainly for the newer operations not included in older textbooks. The whole field of thoracic surgery is well covered, and an excellent bibliography follows each chapter. The illustrations are highly informative, plentiful, and of