Kyobu geka. The Japanese journal of thoracic surgery最新文献

Artificial intelligence (AI) is increasingly enabling multifaceted support in robot-assisted esophagectomy, including automated recognition of surgical phases, identification of critical anatomical structures, and assessment of surgical skills. AI facilitates real-time visualization of surgical progress, reduces the risk of complications, and enhances surgical education. In particular, AI-based support for identifying the recurrent laryngeal nerve and alerting excessive traction serves as a powerful aid to surgeons, contributing to improved surgical quality and safety as a next-generation navigation tool.

In this review article, the latest monitoring systems for vital signs in intensive care units (ICU), presenting illness-severity score, early warning score, are introduced. These systems combined with artificial intelligence might integrate into tele/remote-ICU system, and would provide evidence-based standardized perioperative care after cardiothoracic surgeries, and improve the outcomes of surgeries.

The da Vinci single-port (SP) surgical system is a new system in which a camera and three robotic forceps are inserted into the body through a single small wound for surgical manipulation. This paper outlines the basic techniques and tips for mediastinal tumor surgery using the da Vinci SP, especially the subxiphoid single-port approach. In addition, we will discuss the subcostal approach single-port middle or posterior mediastinal tumor surgery. The subxiphoid approach with the da Vinci SP requires specific tips and precautions, such as avoiding interference between the camera and forceps, forceps and another forceps, forceps and wound margin, and arm and pubic bone or lower extremity, but it is possible to perform thymectomy with good operability and minimal risk. Thymectomy using the da Vinci SP allows for unilateral pleural preservation and surgery that is almost equivalent to an extended thymectomy. Similarly, middle and posterior mediastinal tumor surgery via the subcostal approach with this system requires specific tips and precautions to avoid chylothorax and diaphragmatic hernia, as well as pain management measures such as modified-thoraco-abdominal nerves through perichondrial approach (m-TAPA) block.

According to the progress in medical devices, respirators are improving to avoid ventilator-associated lung injury with new technology and concepts. At first, we need to know the methods of respirator settings; they are the respiratory mode and method. Respiratory modes are assist/control (A/C), synchronized intermittent mandatory ventilation (SIMV), and continuous positive airway pressure (CPAP). The respiratory methods are volume-controlled ventilation (VCV), pressure-controlled ventilation (PCV), and pressure support ventilation (PSV). The new methods of ventilation are airway pressure release ventilation (APRV) and neurally adjusted ventilatory assist (NAVA). To protect the lung injury by ventilation, we need to control the limitation of ventilation volume in one breath, high positive end-expiratory pressure, plateau pressure in lung alveoli, auto positive end-expiratory pressure, and driving pressure in respiration. Coming to the new devices, lung injury would be mitigated by mechanical ventilation.

Previous reports have described cases of aneurysm forming at the repair site of coarctation of the aorta (CoA) decades after initial surgery. We herein report a case of endovascular repair for a ruptured aortic aneurysm that occurred at the repair site of CoA 23 years after the initial surgery. The patient was a 37-year-old man who presented to our hospital for hemoptysis. He previously underwent aortoplasty with direct suture for CoA at the age of 14 years. Computed tomography (CT) revealed a ruptured descending aortic aneurysm with perforation into the left lung;the location of the aneurysm coincided with the site of the previous CoA repair. He underwent emergent thoracic endovascular aortic repair. The postoperative course was uneventful, and the aneurysm was remained stable for over a year after the surgery.

Organ transplantation involves an immune response, and prevention of rejection leads to long-term survival after organ transplantation. In Japan, a physical cross-match (PXM) is performed before organ allocation, in which the donor's lymphocytes are reacted with the recipient's serum, and if an immune response is confirmed, the recipient is excluded from the organ allocation. In other countries, virtual cross-match (VXM) is performed, which is simpler and more accurate, but also has aspects that are difficult to interpret. This article outlines the flow of immunological testing in clinical practice, and describes the principles and practice of physical and virtual cross-match.

Purpose: Our objective is to develop a new device for the treatment of mitral regurgitation by transapical chordal implantation, allowing procedures to be conducted while the heart is beating, thus eliminating the need for extracorporeal circulation. This approach promises both simpler and more reliable procedure than existing devices.

Methods: The target disease is mitral valve prolapse, where adequate coaptation of the anterior and posterior leaflets can be achieved solely through chordal implantation. Our treatment approach involves accessing the mitral valve via the left ventricular apex, attaching an artificial chorda tendineae to the prolapsed mitral valve leaflet, and pulling it to an appropriate length towards the left ventricular apex. We propose the design and operational mechanism of a device to facilitate this procedure.

Results: The device utilizes a grasper with a hollow structure to catch the prolapsed valve leaflet and then attaches the artificial chordae tendineae to the valve leaflet by using a clip within the hollow structure. This structure enables visual confirmation of the procedure using a fiber scope, thus ensuring greater procedural reliability.

Conclusion: This device represents a conceptual breakthrough, although several considerations remain, such as the durability of the materials used and their compatibility with tissue.

In thoracic surgery, general anesthesia remains the standard approach. During the procedure, one-lung ventilation using double-lumen tubes or bronchial blockers is employed as needed. For postoperative pain control, a multimodal approach is taken, incorporating options such as thoracic epidural anesthesia, paravertebral blocks, intercostal nerve blocks, and intravenous patient-controlled analgesia (IV-PCA). These practices have remained consistent in recent years. However, anesthetics and anesthesia-related devices including physiological monitors and ultrasound machines have continued to evolve. As a result, anesthesia today differs significantly from that of a decade ago. This section highlights the latest advances in anesthetics and anesthesia-related technologies, including: (1) the use of artificial intelligence (AI) for monitoring and decision support, (2) robotic anesthesia systems with automated drug delivery, (3) remimazolam as a novel ultra-short-acting sedative, and (4) autologous blood recovery systems capable of platelet collection, improving hemostasis and reducing transfusion requirements. Although the clinical efficacy of these innovations remains to be established through future research, there is considerable anticipation surrounding their potential to enhance the quality of anesthesia management.

Ablation therapy is a minimally invasive local treatment that destroys tumor tissue. It has attracted attention as a treatment option for early-stage lung cancer and metastatic lung tumors. In this review, we provide an overview of the current status of treatment, technical characteristics, indications, and treatment results for three ablation methods for peripheral lung lesions: radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (PCT). RFA is relatively simple to perform, but its therapeutic effect is limited in tumors near blood vessels due to the influence of heat diffusion by blood vessels and bronchi. MWA enables wide-range ablation in a short time compared to RFA and has the advantage of being less affected by blood vessels and bronchi. PCT enables easy confirmation of the ablation range because it can be visualized as an ice ball on computed tomography (CT) fluoroscopy and is less painful for the patient. It is characterized by the induction of tumor cell death by apoptosis and the preservation of tissue structure. The indications for ablation therapy are mainly early-stage non-small cell lung cancer (NSCLC) that is difficult to surgically resect. Patients with high surgical risk, such as elderly patients and patients with serious complications, are targeted. The combination of ablation therapy and immunotherapy is expected to have a therapeutic effect, and systemic antitumor effects through the release of tumor-associated antigens can be expected. In the future, further expansion of treatment options for lung cancer is expected with the development of optimal combination methods with immunotherapy and the development of transbronchial approaches.

The increasing variety of energy devices and modes in thoracic surgery, driven by evolving surgical approaches, presented challenges in selection and understanding. This paper addressed this by reviewing the principles, characteristics, adverse events, and effective application of radiofrequency, ultrasonic, and microwave devices, including recent innovations and soft coagulation. The goal was to guide clinicians towards informed decision-making in their choice of energy modalities.