Background and Objective: Paraesophageal hiatal hernia (PEH) repair has undergone evolution from open approaches (e.g., laparotomy, thoracotomy) to minimally-invasive techniques with laparoscopy. While the laparoscopic approach has offered decreased morbidity, issues related to PEH recurrence persist. As a result, there has been a continued need for innovation of PEH repair techniques to address recurrence. Increased uptake in robotic surgery has allowed for application of this technology to PEH repair. While increasing in adoption, the efficacy of robotic approach to PEH continues to undergo evaluation. Methods: We performed a review of randomized and non-randomized studies surrounding robotic-assisted PEH repair using PubMed/MEDLINE. We evaluated the literature across aspects pertaining to perioperative outcomes, long-term outcomes, and costs compared to traditional surgical approaches. There were no publication date restrictions. Key Content and Findings: Current literature suggests that robotic PEH repair is feasible and offers perioperative outcomes similar to standard laparoscopic approaches. Limited reports of long-term outcomes, specifically related to PEH recurrence and patient-reported outcomes, suggest the efficacy of robotic PEH repair. Initial cost comparisons with standard laparoscopic approaches demonstrate similar intraoperative costs, but are limited and continue to be evaluated. In addition, there is data suggesting robotic PEH repair may be applicable to large PEH (>30% intrathoracic stomach). Conclusions: Review of current literature suggests that robotic PEH repair is feasible and has similar perioperative outcomes when compared to standard laparoscopic techniques. The learning curve for transition from laparoscopic to robotic PEH repair needs to be considered, even among experienced laparoscopic surgeons. Future prospective multi-institutional studies will be needed in order to fully evaluate the value (quality/costs) of robotic PEH repair to ensure efficacious and cost-effective adoption.
{"title":"Application of robotic surgery for paraesophageal hiatal hernia repair: a narrative review","authors":"T. Grenda, R. Reddy","doi":"10.21037/vats-21-44","DOIUrl":"https://doi.org/10.21037/vats-21-44","url":null,"abstract":"Background and Objective: Paraesophageal hiatal hernia (PEH) repair has undergone evolution from open approaches (e.g., laparotomy, thoracotomy) to minimally-invasive techniques with laparoscopy. While the laparoscopic approach has offered decreased morbidity, issues related to PEH recurrence persist. As a result, there has been a continued need for innovation of PEH repair techniques to address recurrence. Increased uptake in robotic surgery has allowed for application of this technology to PEH repair. While increasing in adoption, the efficacy of robotic approach to PEH continues to undergo evaluation. Methods: We performed a review of randomized and non-randomized studies surrounding robotic-assisted PEH repair using PubMed/MEDLINE. We evaluated the literature across aspects pertaining to perioperative outcomes, long-term outcomes, and costs compared to traditional surgical approaches. There were no publication date restrictions. Key Content and Findings: Current literature suggests that robotic PEH repair is feasible and offers perioperative outcomes similar to standard laparoscopic approaches. Limited reports of long-term outcomes, specifically related to PEH recurrence and patient-reported outcomes, suggest the efficacy of robotic PEH repair. Initial cost comparisons with standard laparoscopic approaches demonstrate similar intraoperative costs, but are limited and continue to be evaluated. In addition, there is data suggesting robotic PEH repair may be applicable to large PEH (>30% intrathoracic stomach). Conclusions: Review of current literature suggests that robotic PEH repair is feasible and has similar perioperative outcomes when compared to standard laparoscopic techniques. The learning curve for transition from laparoscopic to robotic PEH repair needs to be considered, even among experienced laparoscopic surgeons. Future prospective multi-institutional studies will be needed in order to fully evaluate the value (quality/costs) of robotic PEH repair to ensure efficacious and cost-effective adoption.","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":"45505605","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}
Non-intubated video-assisted thoracoscopic surgery (NiVATS) has been shown to be a practicable and beneficial procedure for many thoracic operations. This review summarizes the current literature about NiVATS focusing on patients with hyperhidrosis. Seven studies about NiVATS and its efficacy and/or feasibility have been found and are discussed. There are only two randomized trials, while all other reports are case series. Four studies compare NiVATS with VATS. As seen for many other procedures as wedge resection, pleural biopsy and even anatomical resection, NiVATS sympathectomy for hyperhidrosis is a safe and feasible procedure to perform. Especially, due to the usual young, slim and otherwise healthy patients, this method is well suited to start a NiVATS program. Although NiVATS has a short learning curve, it challenges the whole team including surgeons and anesthesiologists, working on an awake patient. Nevertheless, evidence for clinical advantages of NiVATS compared to VATS is still scarce. The majority of thoracic surgery patients still gets a chest tube for a few days, which might outlast the positive effects of NiVATS, as for example lesser anestesiological trauma. However, there is evidence to show that NiVATS might be suitable in managing thoracoscopic sympathectomy as an outpatient operation, as these patients seem to have a faster general recovery postoperatively.
{"title":"NiVATS sympathectomy for hyperhidrosis: should I stay or should I go? A Narrative Review","authors":"Gabriela Haessig, C. Caviezel","doi":"10.21037/vats-21-11","DOIUrl":"https://doi.org/10.21037/vats-21-11","url":null,"abstract":"Non-intubated video-assisted thoracoscopic surgery (NiVATS) has been shown to be a practicable and beneficial procedure for many thoracic operations. This review summarizes the current literature about NiVATS focusing on patients with hyperhidrosis. Seven studies about NiVATS and its efficacy and/or feasibility have been found and are discussed. There are only two randomized trials, while all other reports are case series. Four studies compare NiVATS with VATS. As seen for many other procedures as wedge resection, pleural biopsy and even anatomical resection, NiVATS sympathectomy for hyperhidrosis is a safe and feasible procedure to perform. Especially, due to the usual young, slim and otherwise healthy patients, this method is well suited to start a NiVATS program. Although NiVATS has a short learning curve, it challenges the whole team including surgeons and anesthesiologists, working on an awake patient. Nevertheless, evidence for clinical advantages of NiVATS compared to VATS is still scarce. The majority of thoracic surgery patients still gets a chest tube for a few days, which might outlast the positive effects of NiVATS, as for example lesser anestesiological trauma. However, there is evidence to show that NiVATS might be suitable in managing thoracoscopic sympathectomy as an outpatient operation, as these patients seem to have a faster general recovery postoperatively.","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":"44506303","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}
L. Andriolo, D. A. Fegatelli, A. Spagnoli, G. Rienzo
Roviaro et al . performing the f irst video-assisted thoracoscopic surgery (VATS) lobectomy more than 20 years ago (1), started a new era in lung cancer surgery. The better outcomes compared to “open procedures” in terms of less pain, fewer post-operative complications, reduced chest drainage duration and shorter length of stay has, in fact, prompted nearly every thoracic surgeon in the world to at least attempt to VATS approach. The hypothetical differences in terms of local recurrences and long-term survival of VATS approaches compared with open procedures have been overcome (2) and it is proved by then that VATS lobectomy can offer, if performed by skilled surgeons, a better complications rate and the same safety profile of open surgery. Since 2014 we routinely use the biportal VATS technique for lobectomy and, exceptionally, pneumonectomy (3) Review Article
{"title":"VATS mediastinal lymph node dissection: surgical technique and literature review","authors":"L. Andriolo, D. A. Fegatelli, A. Spagnoli, G. Rienzo","doi":"10.21037/vats-21-27","DOIUrl":"https://doi.org/10.21037/vats-21-27","url":null,"abstract":"Roviaro et al . performing the f irst video-assisted thoracoscopic surgery (VATS) lobectomy more than 20 years ago (1), started a new era in lung cancer surgery. The better outcomes compared to “open procedures” in terms of less pain, fewer post-operative complications, reduced chest drainage duration and shorter length of stay has, in fact, prompted nearly every thoracic surgeon in the world to at least attempt to VATS approach. The hypothetical differences in terms of local recurrences and long-term survival of VATS approaches compared with open procedures have been overcome (2) and it is proved by then that VATS lobectomy can offer, if performed by skilled surgeons, a better complications rate and the same safety profile of open surgery. Since 2014 we routinely use the biportal VATS technique for lobectomy and, exceptionally, pneumonectomy (3) 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":"45358723","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}
C. Diotti, S. Mohamed, M. Cattaneo, F. Damarco, D. Tosi
: Traditionally, lobectomy is the gold standard for early-stage non-small-cell lung cancer (NSCLC) treatment but in recent years lung segmentectomy is gaining a key role in small-sized or subsolid peripheral lung lesion <2 cm. It can be performed with minimally invasive approaches leading to better pulmonary function preservation, less postoperative pain and shorter hospitalization. Although for decades general anesthesia with tracheal intubation was considered mandatory, non-intubated video-assisted thoracic surgery (NiVATS) has been proposed as an alternative to traditional surgery. Its role in more challenging thoracoscopic procedures such as VATS anatomical lung resections is currently being evaluated. NiVATS applied to lung resections for early-stage NSCLC treatment, even if technically more challenging than conventional intubated thoracic surgery, is an innovative and promising surgical strategy allowing less intubation-related adverse effects and a faster recovery; several encouraging results have recently been reported, proving that minimally invasive surgical and anesthetic approaches could be a valid alternative to more invasive procedures in selected patients also in technical challenging anatomical resections. The aim of this review is to describe various technical aspects of NiVATS procedures and to investigate the combination of thoracoscopic segmentectomy and non-intubated anesthesia in terms of feasibility, safety, intra and perioperative complications, short-term outcomes and oncological adequacy.
{"title":"Non-intubated VATS for lung cancer—a focus on segmentectomy: a narrative review","authors":"C. Diotti, S. Mohamed, M. Cattaneo, F. Damarco, D. Tosi","doi":"10.21037/VATS-21-9","DOIUrl":"https://doi.org/10.21037/VATS-21-9","url":null,"abstract":": Traditionally, lobectomy is the gold standard for early-stage non-small-cell lung cancer (NSCLC) treatment but in recent years lung segmentectomy is gaining a key role in small-sized or subsolid peripheral lung lesion <2 cm. It can be performed with minimally invasive approaches leading to better pulmonary function preservation, less postoperative pain and shorter hospitalization. Although for decades general anesthesia with tracheal intubation was considered mandatory, non-intubated video-assisted thoracic surgery (NiVATS) has been proposed as an alternative to traditional surgery. Its role in more challenging thoracoscopic procedures such as VATS anatomical lung resections is currently being evaluated. NiVATS applied to lung resections for early-stage NSCLC treatment, even if technically more challenging than conventional intubated thoracic surgery, is an innovative and promising surgical strategy allowing less intubation-related adverse effects and a faster recovery; several encouraging results have recently been reported, proving that minimally invasive surgical and anesthetic approaches could be a valid alternative to more invasive procedures in selected patients also in technical challenging anatomical resections. The aim of this review is to describe various technical aspects of NiVATS procedures and to investigate the combination of thoracoscopic segmentectomy and non-intubated anesthesia in terms of feasibility, safety, intra and perioperative complications, short-term outcomes and oncological adequacy.","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":"48487547","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 : 2020-11-23DOI: 10.21037/VATS-2019-RCS-08
Ghulam Abbas, Beebarg Raza, Kamil Abbas, J. Lamb, A. Toker
Lung cancer continues to be the leading cause of cancer related deaths both in men and women. Most patients present with locally advanced disease and are not candidates for resection. A recent surge of lung cancer screening programs for high-risk patients across the western world has led to a rising number of patients with early stage lung cancer. These patients with clinical stage I lung cancer and compromised pulmonary reserves can be candidates for sub-lobar resection with curative intention and similar outcomes as compare to lobectomy. Systemic or lobe-specific mediastinal lymph node dissection is an integral part of lung cancer surgery, especially during lobectomy as nodal upstaging can occur up to 18% of clinical stage I lung cancers and is associated with a worse prognosis. Nodal upstaging can occur in N1 lymph nodes only or as a skip metastasis to the N2 lymph nodes or both. The characteristics and location of the tumor plays an important role in lymph node metastasis. Recently, it has been suggested that a lobe-specific mediastinal lymph node dissection is equivalent to multi-station aggressive nodal dissection for early stage lung cancer detected during screening. Determining mediastinal and intersegmental lymph node metastasis is important during segmentectomy as it is associated with an increase recurrence rate and poor survival. These patients are perhaps better served with lobectomy rather than segmentectomy. The techniques and method of standard mediastinal lymph node dissection are well described in literature but description of a systematical approach for N1 lymph node dissection during a segmentectomy to efficiently identify the nodal upstaging intra-operatively, is lacking. We describe a methodological evaluation of N1 lymph node during segmentectomy in an effort to avoid failure to recognize nodal upstaging.
{"title":"Segment-specific lymph node dissection and evaluation during anatomical pulmonary segmentectomy","authors":"Ghulam Abbas, Beebarg Raza, Kamil Abbas, J. Lamb, A. Toker","doi":"10.21037/VATS-2019-RCS-08","DOIUrl":"https://doi.org/10.21037/VATS-2019-RCS-08","url":null,"abstract":"Lung cancer continues to be the leading cause of cancer related deaths both in men and women. Most patients present with locally advanced disease and are not candidates for resection. A recent surge of lung cancer screening programs for high-risk patients across the western world has led to a rising number of patients with early stage lung cancer. These patients with clinical stage I lung cancer and compromised pulmonary reserves can be candidates for sub-lobar resection with curative intention and similar outcomes as compare to lobectomy. Systemic or lobe-specific mediastinal lymph node dissection is an integral part of lung cancer surgery, especially during lobectomy as nodal upstaging can occur up to 18% of clinical stage I lung cancers and is associated with a worse prognosis. Nodal upstaging can occur in N1 lymph nodes only or as a skip metastasis to the N2 lymph nodes or both. The characteristics and location of the tumor plays an important role in lymph node metastasis. Recently, it has been suggested that a lobe-specific mediastinal lymph node dissection is equivalent to multi-station aggressive nodal dissection for early stage lung cancer detected during screening. Determining mediastinal and intersegmental lymph node metastasis is important during segmentectomy as it is associated with an increase recurrence rate and poor survival. These patients are perhaps better served with lobectomy rather than segmentectomy. The techniques and method of standard mediastinal lymph node dissection are well described in literature but description of a systematical approach for N1 lymph node dissection during a segmentectomy to efficiently identify the nodal upstaging intra-operatively, is lacking. We describe a methodological evaluation of N1 lymph node during segmentectomy in an effort to avoid failure to recognize nodal upstaging.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45610233","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}
Robotic-assisted thoracoscopic surgery (RATS), which aims to increase accuracy, and uniportal video-assisted thoracoscopic surgery (U-VATS), which aims to decrease invasiveness, have been reported as new surgical methods for pulmonary resection. The advantages of robotic-assisted surgery include a threedimensional surgical view, elimination of physiological tremors, and enabling surgical manipulation in a natural orientation because of the presence of forceps that move in the same manner as human wrist joints. Therefore, it allows some surgeries that are not feasible with the manual thoracoscopic techniques performed by human hands available currently. Its disadvantages include the lack of tactile sensation, an increased number of ports, the high cost, and unproven commensurate patient benefits. The advantages of uniportal surgery include a lower level of postoperative pain and faster patient recovery because of the single incision, whereas the fact that all surgical instruments are inserted via a single incision, thereby limiting surgical manipulation and decreasing surgical safety and accuracy, represents a disadvantage of this technique. Although many reports have indicated that both robotic-assisted surgery and uniportal surgery are more useful than conventional thoracoscopic surgery, sufficient demonstration based on a high level of evidence remains to be achieved. In the future, the safety, level of invasion, and oncological long-term results of these new surgical methods should be compared with those of conventional surgical methods and investigated regarding their utility.
{"title":"Advantages and disadvantages of robotic and uniportal video-assisted thoracoscopic surgery","authors":"H. Nagano, T. Suda","doi":"10.21037/VATS-20-34","DOIUrl":"https://doi.org/10.21037/VATS-20-34","url":null,"abstract":"Robotic-assisted thoracoscopic surgery (RATS), which aims to increase accuracy, and uniportal video-assisted thoracoscopic surgery (U-VATS), which aims to decrease invasiveness, have been reported as new surgical methods for pulmonary resection. The advantages of robotic-assisted surgery include a threedimensional surgical view, elimination of physiological tremors, and enabling surgical manipulation in a natural orientation because of the presence of forceps that move in the same manner as human wrist joints. Therefore, it allows some surgeries that are not feasible with the manual thoracoscopic techniques performed by human hands available currently. Its disadvantages include the lack of tactile sensation, an increased number of ports, the high cost, and unproven commensurate patient benefits. The advantages of uniportal surgery include a lower level of postoperative pain and faster patient recovery because of the single incision, whereas the fact that all surgical instruments are inserted via a single incision, thereby limiting surgical manipulation and decreasing surgical safety and accuracy, represents a disadvantage of this technique. Although many reports have indicated that both robotic-assisted surgery and uniportal surgery are more useful than conventional thoracoscopic surgery, sufficient demonstration based on a high level of evidence remains to be achieved. In the future, the safety, level of invasion, and oncological long-term results of these new surgical methods should be compared with those of conventional surgical methods and investigated regarding their utility.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48795946","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 : 2020-09-18DOI: 10.21037/VATS-2020-LM-08
F. Fiorentino, M. Milošević, T. Treasure
: The majority of lung metastasectomy operations are for colorectal cancer (CRC). The practice is highly selective. Of patients who have had a potentially curative resection, about 2–3% subsequently have a lung metastasectomy. The motive for operation is to cure the patient by removing the only evident remaining cancer. We review the methods used to investigate the evidence on which this practice is based, going from review of published observational cohort studies, through a citation network to a randomised controlled trial (RCT). The non-inferiority RCT Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) compared survival, quality of life, and health utility in 46 patients randomised to metastasectomy and 47 control patients. The two arms were well balanced for the known prognostic characteristics: the number of metastases, carcinoembryonic antigen levels, previous liver metastasectomy, cancer stage, and the interval since primary resection. Median survival was similar in the two arms: 3.5 years after metastasectomy and 3.8 years among controls and hazard ratio for death within five years of 0.93 (95% CI: 0.56–1.56). There were 12 five-year survivors after metastasectomy and 11 among controls. The size of the trial does not exclude the possibility of occasional long-term survivors in whom metastasectomy appears to have removed the only residue of cancer, as has been observed anecdotally. As might be expected, after metastasectomy there was a decline in lung function as measured by % predicted FEV1. There were also more lung symptoms among the patient reported outcomes. The decline in self-reported health state was similar in the two arms. The generally assumed near zero five-year survival without metastasectomy was not found in PulMiCC or in the control groups of two other randomised studies, CLOCC and SABRE-COMET. Patients, and those treating for them, should be aware of this new information in reaching a decision about lung metastasectomy.
{"title":"What have we learned in the process of setting up and running the PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer) randomised controlled trial?","authors":"F. Fiorentino, M. Milošević, T. Treasure","doi":"10.21037/VATS-2020-LM-08","DOIUrl":"https://doi.org/10.21037/VATS-2020-LM-08","url":null,"abstract":": The majority of lung metastasectomy operations are for colorectal cancer (CRC). The practice is highly selective. Of patients who have had a potentially curative resection, about 2–3% subsequently have a lung metastasectomy. The motive for operation is to cure the patient by removing the only evident remaining cancer. We review the methods used to investigate the evidence on which this practice is based, going from review of published observational cohort studies, through a citation network to a randomised controlled trial (RCT). The non-inferiority RCT Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) compared survival, quality of life, and health utility in 46 patients randomised to metastasectomy and 47 control patients. The two arms were well balanced for the known prognostic characteristics: the number of metastases, carcinoembryonic antigen levels, previous liver metastasectomy, cancer stage, and the interval since primary resection. Median survival was similar in the two arms: 3.5 years after metastasectomy and 3.8 years among controls and hazard ratio for death within five years of 0.93 (95% CI: 0.56–1.56). There were 12 five-year survivors after metastasectomy and 11 among controls. The size of the trial does not exclude the possibility of occasional long-term survivors in whom metastasectomy appears to have removed the only residue of cancer, as has been observed anecdotally. As might be expected, after metastasectomy there was a decline in lung function as measured by % predicted FEV1. There were also more lung symptoms among the patient reported outcomes. The decline in self-reported health state was similar in the two arms. The generally assumed near zero five-year survival without metastasectomy was not found in PulMiCC or in the control groups of two other randomised studies, CLOCC and SABRE-COMET. Patients, and those treating for them, should be aware of this new information in reaching a decision about lung metastasectomy.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47482597","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 : 2020-09-14DOI: 10.21037/VATS-2020-LM-07
Jorge Hernández, J. Fiblà, L. Molins
{"title":"Video-assisted thoracoscopic surgery in lung metastasectomy—what is new in lung metastasectomy: an over-view","authors":"Jorge Hernández, J. Fiblà, L. Molins","doi":"10.21037/VATS-2020-LM-07","DOIUrl":"https://doi.org/10.21037/VATS-2020-LM-07","url":null,"abstract":"","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44920303","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}
A. Ojanguren, M. Sauvain, C. Forster, Michel Gonzalez
Pulmonary segmentectomy is a parenchyma-sparing technique that is currently proposed for diagnosis of centrally located nodules or definitive treatment of metastases or early stage non-small cell lung cancer. However, pulmonary segmentectomy is a technically more challenging procedure than lobectomy that requires individual dissection of segmental broncho-vascular structures and identification of the intersegmental plane to prevent incomplete resection and post-operative complications. Segmentectomy is now performed through the use of video-assisted thoracic surgery (VATS). Segmentectomies can be classified into simple and complex based on the difficulty to separate several intersegmental planes. Segmentectomies of the lower lobes are technically feasible by VATS but remain challenging, especially since standardization reports are still lacking. However, this procedure is interesting because the greatest part of pulmonary perfusion and function is located in the lower lobe. Although the posterior basal (S) is recognized as one the most challenging anatomical segmentectomy, it could be safely performed by uniportal VATS. Our approach consists in opening first the intersegmental between S and S by using an intersegmental tunneling technique. This technique permits the accurate identification of the bronchovascular structures of the segment S. Intra-operative assistance with indocyanine green (ICG) near-infrared angiography may help surgeons identify the intersegmental plane during these complex segmentectomies.
{"title":"Uniportal S10 segmentectomy by transfissural intersegmental tunneling","authors":"A. Ojanguren, M. Sauvain, C. Forster, Michel Gonzalez","doi":"10.21037/vats-20-41","DOIUrl":"https://doi.org/10.21037/vats-20-41","url":null,"abstract":"Pulmonary segmentectomy is a parenchyma-sparing technique that is currently proposed for diagnosis of centrally located nodules or definitive treatment of metastases or early stage non-small cell lung cancer. However, pulmonary segmentectomy is a technically more challenging procedure than lobectomy that requires individual dissection of segmental broncho-vascular structures and identification of the intersegmental plane to prevent incomplete resection and post-operative complications. Segmentectomy is now performed through the use of video-assisted thoracic surgery (VATS). Segmentectomies can be classified into simple and complex based on the difficulty to separate several intersegmental planes. Segmentectomies of the lower lobes are technically feasible by VATS but remain challenging, especially since standardization reports are still lacking. However, this procedure is interesting because the greatest part of pulmonary perfusion and function is located in the lower lobe. Although the posterior basal (S) is recognized as one the most challenging anatomical segmentectomy, it could be safely performed by uniportal VATS. Our approach consists in opening first the intersegmental between S and S by using an intersegmental tunneling technique. This technique permits the accurate identification of the bronchovascular structures of the segment S. Intra-operative assistance with indocyanine green (ICG) near-infrared angiography may help surgeons identify the intersegmental plane during these complex segmentectomies.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48768169","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 : 2020-06-01DOI: 10.21037/VATS.2020.02.03
Samina Park, C. Kang, Hyun Joo Lee, I. Park, Y. T. Kim
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea Contributions: (I) Conception and design: S Park, CH Kang; (II) Administrative support: All authors; (III) Provision of study materials or patients S Park, CH Kang; (IV) Collection and assembly of data: S Park, CH Kang; (V) Data analysis and interpretation: S Park, CH Kang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Chang Hyun Kang, MD, PhD. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea. Email: chkang@snu.ac.kr.
{"title":"Impact of the number of resected lymph nodes during multi-portal VATS lobectomy for clinical N0 non-small cell lung cancer","authors":"Samina Park, C. Kang, Hyun Joo Lee, I. Park, Y. T. Kim","doi":"10.21037/VATS.2020.02.03","DOIUrl":"https://doi.org/10.21037/VATS.2020.02.03","url":null,"abstract":"Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea Contributions: (I) Conception and design: S Park, CH Kang; (II) Administrative support: All authors; (III) Provision of study materials or patients S Park, CH Kang; (IV) Collection and assembly of data: S Park, CH Kang; (V) Data analysis and interpretation: S Park, CH Kang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Chang Hyun Kang, MD, PhD. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongro-gu, Seoul 03080, South Korea. Email: chkang@snu.ac.kr.","PeriodicalId":42086,"journal":{"name":"Video-Assisted Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49522867","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：