{"title":"Ni-VATS for interstitial lung disease—where are we now?","authors":"R. Cherchi, P. Ferrari, F. Guerrera","doi":"10.21037/VATS-21-19","DOIUrl":"https://doi.org/10.21037/VATS-21-19","url":null,"abstract":"","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42104847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Non-intubated thoracic surgery—the surgeon perspective","authors":"D. Divisi, G. Zaccagna, A. D. Vico, R. Crisci","doi":"10.21037/VATS-21-6","DOIUrl":"https://doi.org/10.21037/VATS-21-6","url":null,"abstract":"","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47498061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-20DOI: 10.21037/VATS-2019-OC-07
M. Mun
Since the 1960s, lobectomy with systemic lymph node (LN) dissection has been the standard surgical treatment for patients with stage I or II non-small cell lung cancer (NSCLC). The efficacy of LN dissection for lung cancer depends on the accurate staging and the likelihood of survival benefit. After surgical resection, 10–20% of clinical N0 lung cancer converts to pathologic N1 or N2 disease. Moreover, evaluating the postoperative locoregional recurrences at the dissected area is an important factor to judge the proper approach for lung cancer surgery. Although video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer is increasingly accepted as a minimally invasive surgery, it is now widely performed with a lack of clear evidence regarding the clearance of the LN dissection. Furthermore, the novel minimally invasive approaches, such as the single-port VATS and the robotic-assisted thoracic surgery, have increased in adaptation for lung cancer surgery in the past decade. This focused series is directed to the thoracic surgeons who are performing the minimally invasive surgery for early-stage lung cancer. Experts on each minimally invasive approach will comprehensively introduce their techniques and the results of their oncological clearance. Further prospective randomized controlled trials that compare each minimally invasive approach for early-stage lung cancer are needed to evaluate the oncological efficacy of these minimally invasive approaches.
{"title":"Oncological clearance of minimally invasive approaches for clinical N0 non-small cell lung cancer","authors":"M. Mun","doi":"10.21037/VATS-2019-OC-07","DOIUrl":"https://doi.org/10.21037/VATS-2019-OC-07","url":null,"abstract":"Since the 1960s, lobectomy with systemic lymph node (LN) dissection has been the standard surgical treatment for patients with stage I or II non-small cell lung cancer (NSCLC). The efficacy of LN dissection for lung cancer depends on the accurate staging and the likelihood of survival benefit. After surgical resection, 10–20% of clinical N0 lung cancer converts to pathologic N1 or N2 disease. Moreover, evaluating the postoperative locoregional recurrences at the dissected area is an important factor to judge the proper approach for lung cancer surgery. Although video-assisted thoracoscopic surgery (VATS) lobectomy for lung cancer is increasingly accepted as a minimally invasive surgery, it is now widely performed with a lack of clear evidence regarding the clearance of the LN dissection. Furthermore, the novel minimally invasive approaches, such as the single-port VATS and the robotic-assisted thoracic surgery, have increased in adaptation for lung cancer surgery in the past decade. This focused series is directed to the thoracic surgeons who are performing the minimally invasive surgery for early-stage lung cancer. Experts on each minimally invasive approach will comprehensively introduce their techniques and the results of their oncological clearance. Further prospective randomized controlled trials that compare each minimally invasive approach for early-stage lung cancer are needed to evaluate the oncological efficacy of these minimally invasive approaches.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46321219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: The optimal approach for repairing large paraesophageal hernia (PEH) is unclear. Historically, these were initially approached through a transthoracic incision, then shifted to a laparotomy. Now laparoscopy has been the most common approach for at least the past decade, during which time the robotic approach has also increased in utilization. This article reviews the pros and cons of the different approaches, including recurrence rates, morbidity, and mortality. Using this information, we propose a general framework for the utilization of each approach as a reference for surgeons in their clinical decision making and operative planning. Laparoscopic (and/or robotic) approaches are best suited for small PEHs or cases of reflux alone. Robotic technology can aid in crural repair and potentially reduce long-term recurrence compared to traditional laparoscopy, while maintaining the benefits of quicker recovery. A laparotomy should generally be reserved for patients with recurrent PEH and severe intra-abdominal adhesions or urgent situations such as obstruction, gangrene, or conversion from laparoscopy. Due to the high risk of recurrence, patients with larger PEHs (type III or IV) or risk factors for recurrence (obesity, shortened esophagus, chronic cough, or constipation), should be strongly considered for a transthoracic approach. It is unclear if mesh offers benefits long term, but there is a small incidence of catastrophic mesh complications that should also be considered. Non-operative management of PEH, though occasionally utilized for asymptomatic patients, should generally be avoided due to a high risk of PEH-related complications and mortality. 9
{"title":"Choosing the best approach for paraesophageal hiatal hernia repair: a narrative review","authors":"Brian P. Fallon, R. Reddy","doi":"10.21037/vats-21-13","DOIUrl":"https://doi.org/10.21037/vats-21-13","url":null,"abstract":": The optimal approach for repairing large paraesophageal hernia (PEH) is unclear. Historically, these were initially approached through a transthoracic incision, then shifted to a laparotomy. Now laparoscopy has been the most common approach for at least the past decade, during which time the robotic approach has also increased in utilization. This article reviews the pros and cons of the different approaches, including recurrence rates, morbidity, and mortality. Using this information, we propose a general framework for the utilization of each approach as a reference for surgeons in their clinical decision making and operative planning. Laparoscopic (and/or robotic) approaches are best suited for small PEHs or cases of reflux alone. Robotic technology can aid in crural repair and potentially reduce long-term recurrence compared to traditional laparoscopy, while maintaining the benefits of quicker recovery. A laparotomy should generally be reserved for patients with recurrent PEH and severe intra-abdominal adhesions or urgent situations such as obstruction, gangrene, or conversion from laparoscopy. Due to the high risk of recurrence, patients with larger PEHs (type III or IV) or risk factors for recurrence (obesity, shortened esophagus, chronic cough, or constipation), should be strongly considered for a transthoracic approach. It is unclear if mesh offers benefits long term, but there is a small incidence of catastrophic mesh complications that should also be considered. Non-operative management of PEH, though occasionally utilized for asymptomatic patients, should generally be avoided due to a high risk of PEH-related complications and mortality. 9","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47608746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surgery and anesthesia in the thoracic pathways of the new era: a move on to the future","authors":"F. Guerrera, P. Ferrari, R. Crisci","doi":"10.21037/vats-2021-01","DOIUrl":"https://doi.org/10.21037/vats-2021-01","url":null,"abstract":"","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48369520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lungs are the second most frequent metastatic site following the liver. Nearly 30% of patients affected by a solid malignant tumor, will further develop pulmonary metastasis (1,2). Surgical resection of lung metastases is considered a valid therapeutic option for different malignant diseases. Pulmonary metastasectomy (PM) is generally indicated in patients who can tolerate single or multiple resections and when all lesions can be radically removed (3). To date, there are no clear guidelines on the optimal surgical approach and type of resection for this group of patients; the role of lymph node assessment is not clearly defined as well. Review Article
{"title":"Non-intubated video-assisted pulmonary metastasectomy: a narrative literature review","authors":"L. Gherzi, M. Ferrari, Alessandro Pardolesi","doi":"10.21037/vats-21-30","DOIUrl":"https://doi.org/10.21037/vats-21-30","url":null,"abstract":"Lungs are the second most frequent metastatic site following the liver. Nearly 30% of patients affected by a solid malignant tumor, will further develop pulmonary metastasis (1,2). Surgical resection of lung metastases is considered a valid therapeutic option for different malignant diseases. Pulmonary metastasectomy (PM) is generally indicated in patients who can tolerate single or multiple resections and when all lesions can be radically removed (3). To date, there are no clear guidelines on the optimal surgical approach and type of resection for this group of patients; the role of lymph node assessment is not clearly defined as well. Review Article","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44396059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
to review the approach to revisional paraesophageal hernia repair. Background: Recurrence after a successful paraesophageal hernia repair is not uncommon and appears to be a time dependent phenomenon. Revisional surgery is required in approx. 15% of patients and is associated with increased morbidity and mortality. Challenging aspects of revisional surgery include distorted anatomy, adhesions and possible presence of mesh which increases risk of esophageal perforation, gastric perforation, vagal nerve injury and splenic injury. Methods: We reviewed our own institutional experience and recent literature for approach, techniques and outcomes of revisional paraesophageal hernia surgery. Conclusions: A thorough investigation can reveal the etiology of failure/symptoms and is vital in formulating an operative plan. Manometry, esophagogastroduodenoscopy (EGD), computed tomography (CT) scan, esophagogram, gastric emptying studies and pH studies all form part of the work-up. Transabdominal approaches (minimally invasive or open) are the most common. Left transthoracic and thoracoabdominal are options in case of a hostile abdomen. Key operative steps in redo repair include reduction of hernia, excision of remaining sac if present, restoring correct anatomy, ensuring adequate intra-abdominal esophagus, possible esophageal lengthening, and robust crural closure with revision of fundoplication. Cautious post-op management and slow diet advancement is applied with yearly monitoring for early identification of issues.
{"title":"Re-operative surgery after paraesophageal hernia repair: narrative review","authors":"M. Sudarshan, S. Raja","doi":"10.21037/vats-21-31","DOIUrl":"https://doi.org/10.21037/vats-21-31","url":null,"abstract":"to review the approach to revisional paraesophageal hernia repair. Background: Recurrence after a successful paraesophageal hernia repair is not uncommon and appears to be a time dependent phenomenon. Revisional surgery is required in approx. 15% of patients and is associated with increased morbidity and mortality. Challenging aspects of revisional surgery include distorted anatomy, adhesions and possible presence of mesh which increases risk of esophageal perforation, gastric perforation, vagal nerve injury and splenic injury. Methods: We reviewed our own institutional experience and recent literature for approach, techniques and outcomes of revisional paraesophageal hernia surgery. Conclusions: A thorough investigation can reveal the etiology of failure/symptoms and is vital in formulating an operative plan. Manometry, esophagogastroduodenoscopy (EGD), computed tomography (CT) scan, esophagogram, gastric emptying studies and pH studies all form part of the work-up. Transabdominal approaches (minimally invasive or open) are the most common. Left transthoracic and thoracoabdominal are options in case of a hostile abdomen. Key operative steps in redo repair include reduction of hernia, excision of remaining sac if present, restoring correct anatomy, ensuring adequate intra-abdominal esophagus, possible esophageal lengthening, and robust crural closure with revision of fundoplication. Cautious post-op management and slow diet advancement is applied with yearly monitoring for early identification of issues.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44142187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Leoncini, D. Magnini, V. Livi, M. Flore, L. M. Porro, D. Paioli, R. Trisolini
The endoscopic assessment of the mediastinal status has become extremely widespread in the last two decades due to its safety and efficacy. While in patients with known/suspected advanced lung cancer sampling of the mediastinal lymph nodes is often carried out as the diagnostic success of endosonography is higher than that of guided bronchoscopy aimed at sampling a peripheral primary tumor, in patients with potentially operable disease a thorough mediastinal staging is key for therapeutic decision-making. While imaging studies such as computed tomography (CT) and 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) are commonly used as first step approach in patients with suspected lung cancer, their diagnostic accuracy is insufficient and a tissue diagnosis is usually required to confirm or rule out reliably the metastatic involvement of hilar or mediastinal lymph nodes. The aim of the present review is to describe the role of endosonography [endobronchial ultrasound (EBUS); esophageal ultrasound (EUS)] in the mediastinal staging of lung cancer. Besides the rationale, equipment, and indications for endosonography in this setting, more controversial issues such as the staging strategy (“hit and run” versus systematic staging”), the role of the endosonographic staging in certain categories of patients with cN0 lung cancer, the importance of a surgical staging after a negative endosonographic evaluation, and the current means of risk stratification will be briefly discussed.
{"title":"Endosonography in mediastinal staging of lung cancer: a concise literature review","authors":"F. Leoncini, D. Magnini, V. Livi, M. Flore, L. M. Porro, D. Paioli, R. Trisolini","doi":"10.21037/vats-21-25","DOIUrl":"https://doi.org/10.21037/vats-21-25","url":null,"abstract":"The endoscopic assessment of the mediastinal status has become extremely widespread in the last two decades due to its safety and efficacy. While in patients with known/suspected advanced lung cancer sampling of the mediastinal lymph nodes is often carried out as the diagnostic success of endosonography is higher than that of guided bronchoscopy aimed at sampling a peripheral primary tumor, in patients with potentially operable disease a thorough mediastinal staging is key for therapeutic decision-making. While imaging studies such as computed tomography (CT) and 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) are commonly used as first step approach in patients with suspected lung cancer, their diagnostic accuracy is insufficient and a tissue diagnosis is usually required to confirm or rule out reliably the metastatic involvement of hilar or mediastinal lymph nodes. The aim of the present review is to describe the role of endosonography [endobronchial ultrasound (EBUS); esophageal ultrasound (EUS)] in the mediastinal staging of lung cancer. Besides the rationale, equipment, and indications for endosonography in this setting, more controversial issues such as the staging strategy (“hit and run” versus systematic staging”), the role of the endosonographic staging in certain categories of patients with cN0 lung cancer, the importance of a surgical staging after a negative endosonographic evaluation, and the current means of risk stratification will be briefly discussed.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49144467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Rosboch, E. Ceraolo, E. Balzani, F. Piccioni, L. Brazzi
We are facing an era of great challenges and opportunities. Since new requests arise, new answers should be offered to our patients, especially to the more fragile ones. Cooperation between anesthesiologists and thoracic surgeons plays a pivotal role in successfully managing difficult procedures in vulnerable patients. Non-Intubated Thoracic Surgery (NITS) is among the techniques found effective to handle this population, offering a number of surgical opportunities for patients who are too risky for general anesthesia (GA): one-lung ventilation under spontaneous breathing allows maintaining a better match of ventilation and perfusion; respiratory efficiency can be guaranteed by a preserved diaphragmatic function, intubation-related trauma and mechanical ventilation are avoided, and no residual neuromuscular blockage problems occur. Nevertheless, the intraoperative management, as well as management in critical situations, is quite different during NITS compared to the standard procedures performed under GA. We will briefly discuss some key topics, starting from the Anesthesiologist’s Perspective, while keeping in mind that a multidisciplinary approach is essential for safe and effective management.
{"title":"The anesthesiologist perspective","authors":"G. Rosboch, E. Ceraolo, E. Balzani, F. Piccioni, L. Brazzi","doi":"10.21037/VATS-21-2","DOIUrl":"https://doi.org/10.21037/VATS-21-2","url":null,"abstract":"We are facing an era of great challenges and opportunities. Since new requests arise, new answers should be offered to our patients, especially to the more fragile ones. Cooperation between anesthesiologists and thoracic surgeons plays a pivotal role in successfully managing difficult procedures in vulnerable patients. Non-Intubated Thoracic Surgery (NITS) is among the techniques found effective to handle this population, offering a number of surgical opportunities for patients who are too risky for general anesthesia (GA): one-lung ventilation under spontaneous breathing allows maintaining a better match of ventilation and perfusion; respiratory efficiency can be guaranteed by a preserved diaphragmatic function, intubation-related trauma and mechanical ventilation are avoided, and no residual neuromuscular blockage problems occur. Nevertheless, the intraoperative management, as well as management in critical situations, is quite different during NITS compared to the standard procedures performed under GA. We will briefly discuss some key topics, starting from the Anesthesiologist’s Perspective, while keeping in mind that a multidisciplinary approach is essential for safe and effective management.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48786048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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