Pub Date : 2025-12-01Epub Date: 2025-07-28DOI: 10.1016/j.atssr.2025.06.029
Isheeta Madeka MD , Gregory L. Whitehorn BS , Annie Ho MS , Anurag Ishwar BS , Sneha Alaparthi MD , Tyler R. Grenda MD , Nathaniel R. Evans III MD , Olugbenga T. Okusanya MD
Background
Recent studies have shown a high-quality wedge resection to be equivalent to lobectomy for small, early-stage non-small cell lung cancer (NSCLC). High-quality wedge resections include compliance with 3+1 lymph node sampling (LNS). We aimed to evaluate whether robotic-assisted wedges are more likely to comply with 3+1 LNS.
Methods
The Society of Thoracic Surgeons General Thoracic Database was queried for patients with clinical T1 N0 M0 NSCLC who underwent wedge resection with LNS between July 2021 and January 2023. Multivariable regression was used to examine factors associated with 3+1 LNS.
Results
A total of 4162 patients were identified; 1815 (43.6%) underwent 3+1 LNS. Patients in the 3+1 LNS group were less likely to undergo open operations (4.6% vs 6.0%) or video-assisted thoracoscopic surgery (VATS) (40.2% vs 60.8%) (P < .001). The robotic approach had the largest association with compliance (vs VATS; odds ratio, 2.53; 95% CI, 2.22-2.90; P < .001).
Conclusions
Less than one-half of patients with early-stage NSCLC who were treated with wedge resection satisfied 3+1 LNS. Patients who underwent robotic-assisted wedge resection were 2.5 times more likely to undergo guideline-concordant LNS. The robotic approach was the most significant factor in achieving 3+1 LNS.
最近的研究表明，对于小的、早期的非小细胞肺癌（NSCLC），高质量的楔形切除术与肺叶切除术相当。高质量的楔形切除包括符合3+1淋巴结取样（LNS）。我们的目的是评估机器人辅助的楔形是否更有可能符合3+1 LNS。方法查询美国胸外科学会（Society of Thoracic Surgeons）胸椎数据库中于2021年7月至2023年1月间行楔形切除联合LNS的临床T1 N0 M0 NSCLC患者。采用多变量回归分析与3+1 LNS相关的因素。结果共检出4162例患者；1815例（43.6%）行3+1次LNS。3+1 LNS组患者较少接受开放手术（4.6% vs 6.0%）或电视胸腔镜手术（VATS） （40.2% vs 60.8%） （P < .001）。机器人方法与依从性的关联最大（vs VATS；优势比，2.53;95% CI, 2.22-2.90; P < .001）。结论楔形切除的早期NSCLC患者中，满足3+1 LNS的不到一半。接受机器人辅助的楔形切除的患者接受符合指南的LNS的可能性是前者的2.5倍。机器人方法是实现3+1 LNS的最重要因素。
{"title":"Is Robotic-Assisted Surgery Associated With Receipt of Guideline-Directed Lymph Node Sampling in Wedge Resection for Early-Stage NSCLC?","authors":"Isheeta Madeka MD , Gregory L. Whitehorn BS , Annie Ho MS , Anurag Ishwar BS , Sneha Alaparthi MD , Tyler R. Grenda MD , Nathaniel R. Evans III MD , Olugbenga T. Okusanya MD","doi":"10.1016/j.atssr.2025.06.029","DOIUrl":"10.1016/j.atssr.2025.06.029","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies have shown a high-quality wedge resection to be equivalent to lobectomy for small, early-stage non-small cell lung cancer (NSCLC). High-quality wedge resections include compliance with 3+1 lymph node sampling (LNS). We aimed to evaluate whether robotic-assisted wedges are more likely to comply with 3+1 LNS.</div></div><div><h3>Methods</h3><div>The Society of Thoracic Surgeons General Thoracic Database was queried for patients with clinical T1 N0 M0 NSCLC who underwent wedge resection with LNS between July 2021 and January 2023. Multivariable regression was used to examine factors associated with 3+1 LNS.</div></div><div><h3>Results</h3><div>A total of 4162 patients were identified; 1815 (43.6%) underwent 3+1 LNS. Patients in the 3+1 LNS group were less likely to undergo open operations (4.6% vs 6.0%) or video-assisted thoracoscopic surgery (VATS) (40.2% vs 60.8%) (<em>P</em> < .001). The robotic approach had the largest association with compliance (vs VATS; odds ratio, 2.53; 95% CI, 2.22-2.90; <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Less than one-half of patients with early-stage NSCLC who were treated with wedge resection satisfied 3+1 LNS. Patients who underwent robotic-assisted wedge resection were 2.5 times more likely to undergo guideline-concordant LNS. The robotic approach was the most significant factor in achieving 3+1 LNS.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 856-860"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-13DOI: 10.1016/j.atssr.2025.05.021
Usha Gurunathan FANZCA , Vincent Loo MBBS , Rishendran Naidoo FRACS , Sayonne Sivalingam MBBS , Stephanie Yerkovich PhD, MBiostats , Daniel Mullany FCICM, PhD
Background
Inadequate time for preoperative optimization can lead to adverse outcomes after urgent cardiac surgical procedures. In this audit, we compared the incidence of postoperative pulmonary complications (PPCs) and other adverse outcomes after elective and urgent cardiac surgical procedures.
Methods
Adult patients who underwent nonemergency open heart surgical procedures were included. PPCs were defined as a composite of atelectasis, pneumonia, acute respiratory distress syndrome, respiratory failure, and pulmonary aspiration. Logistic regression analysis identified factors associated with PPCs. Other pulmonary and systemic complications were examined.
Results
In a sample of 6138 patients, PPCs were observed in 1996 (32.5%) participants. The urgent group had higher rates of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism compared with elective patients (P < .001). Mild and moderate-severe respiratory diseases were associated with PPCs (adjusted odds ratio [OR], 1.34; 95% CI, 1.14-1.58; P < .001 and OR, 1.66; 95% CI, 1.32-2.09; P < .001, respectively). Other associated factors included age (P = .006), coronary artery bypass surgery, obesity, reduced left ventricular ejection fraction, preoperative creatinine level, and perfusion time (P < .001).
Conclusions
Pulmonary complications increased after urgent compared with elective cardiac surgical procedures, with a higher incidence of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism.
{"title":"Pulmonary Complications After Cardiac Surgical Procedures: A Tertiary Centre Audit of Elective and Urgent Cases","authors":"Usha Gurunathan FANZCA , Vincent Loo MBBS , Rishendran Naidoo FRACS , Sayonne Sivalingam MBBS , Stephanie Yerkovich PhD, MBiostats , Daniel Mullany FCICM, PhD","doi":"10.1016/j.atssr.2025.05.021","DOIUrl":"10.1016/j.atssr.2025.05.021","url":null,"abstract":"<div><h3>Background</h3><div>Inadequate time for preoperative optimization can lead to adverse outcomes after urgent cardiac surgical procedures. In this audit, we compared the incidence of postoperative pulmonary complications (PPCs) and other adverse outcomes after elective and urgent cardiac surgical procedures.</div></div><div><h3>Methods</h3><div>Adult patients who underwent nonemergency open heart surgical procedures were included. PPCs were defined as a composite of atelectasis, pneumonia, acute respiratory distress syndrome, respiratory failure, and pulmonary aspiration. Logistic regression analysis identified factors associated with PPCs. Other pulmonary and systemic complications were examined.</div></div><div><h3>Results</h3><div>In a sample of 6138 patients, PPCs were observed in 1996 (32.5%) participants. The urgent group had higher rates of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism compared with elective patients (<em>P</em> < .001). Mild and moderate-severe respiratory diseases were associated with PPCs (adjusted odds ratio [OR], 1.34; 95% CI, 1.14-1.58; <em>P</em> < .001 and OR, 1.66; 95% CI, 1.32-2.09; <em>P</em> < .001, respectively). Other associated factors included age (<em>P</em> = .006), coronary artery bypass surgery, obesity, reduced left ventricular ejection fraction, preoperative creatinine level, and perfusion time (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>Pulmonary complications increased after urgent compared with elective cardiac surgical procedures, with a higher incidence of pneumonia, respiratory failure, pleural effusion, and pulmonary embolism.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1141-1145"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-17DOI: 10.1016/j.atssr.2025.05.022
W. Samir Cubas MD, MSc , Maximiliano Hernandez MD , Santiago Cubas MD , Carolina Sosa Vota MD , Juan Andrés Montero MD , Gerardo Soca MD, MSc , Victor Dayan MD, PhD
Background
The academic and research contributions of cardiovascular scientific surgeons in Latin America have remained largely unnoticed. This study analyzes the bibliometric production of cardiovascular scientific surgeons over the past 20 years and its impact on Latin American cardiovascular surgery.
Methods
A bibliometric-visual study was conducted using the Scopus database (2004-2024) with 95 major thesauri in Latin American cardiovascular surgery. Data on publications, authorship, citations, trends, collaborative networks, journals, topics, sponsorship, and economic development factors were analyzed using the R bibliometrix package and Stata software.
Results
A total of 8559 publications and 47,171 authors (2.5% of global output) were analyzed, with 77.41% being original articles or case reports. Brazil led scientific production (47.26%), with international coauthorship at 33.12%. The most cited journal was the Brazilian Journal of Cardiovascular Surgery (quartile 3). Coronary-valvular surgery (56.17%) was the predominant topic. Despite a 61.1% drop in 2023-2024, predictive models suggest recovery by early 2025, surpassing previous levels (P = .0001). A moderate correlation between scientific production and GDP per capita was found (P = .0024).
Conclusions
This is the first bibliometric analysis of cardiovascular scientific surgeons in Latin America, highlighting significant growth despite challenges. Predictive models suggest a potential for the highest production in 20 years by 2025 in the post-pandemic era. Stronger research policies, increased funding, and enhanced collaboration are essential to sustain growth.
{"title":"Latin America's Cardiovascular Scientific Surgeons: A 20-Year Visual and Bibliometric Journey of Resilience","authors":"W. Samir Cubas MD, MSc , Maximiliano Hernandez MD , Santiago Cubas MD , Carolina Sosa Vota MD , Juan Andrés Montero MD , Gerardo Soca MD, MSc , Victor Dayan MD, PhD","doi":"10.1016/j.atssr.2025.05.022","DOIUrl":"10.1016/j.atssr.2025.05.022","url":null,"abstract":"<div><h3>Background</h3><div>The academic and research contributions of cardiovascular scientific surgeons in Latin America have remained largely unnoticed. This study analyzes the bibliometric production of cardiovascular scientific surgeons over the past 20 years and its impact on Latin American cardiovascular surgery.</div></div><div><h3>Methods</h3><div>A bibliometric-visual study was conducted using the Scopus database (2004-2024) with 95 major thesauri in Latin American cardiovascular surgery. Data on publications, authorship, citations, trends, collaborative networks, journals, topics, sponsorship, and economic development factors were analyzed using the R bibliometrix package and Stata software.</div></div><div><h3>Results</h3><div>A total of 8559 publications and 47,171 authors (2.5% of global output) were analyzed, with 77.41% being original articles or case reports. Brazil led scientific production (47.26%), with international coauthorship at 33.12%. The most cited journal was the <em>Brazilian Journal of Cardiovascular Surgery</em> (quartile 3). Coronary-valvular surgery (56.17%) was the predominant topic. Despite a 61.1% drop in 2023-2024, predictive models suggest recovery by early 2025, surpassing previous levels (<em>P</em> = .0001). A moderate correlation between scientific production and GDP per capita was found (<em>P</em> = .0024).</div></div><div><h3>Conclusions</h3><div>This is the first bibliometric analysis of cardiovascular scientific surgeons in Latin America, highlighting significant growth despite challenges. Predictive models suggest a potential for the highest production in 20 years by 2025 in the post-pandemic era. Stronger research policies, increased funding, and enhanced collaboration are essential to sustain growth.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1148-1153"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-07-21DOI: 10.1016/j.atssr.2025.06.016
Ali Hemyari MD , Allison B. Davila MD , Michael A. Evans MD, FAAP
Thoracic duct identification during surgery in small children is often difficult or impossible secondary to patient size, surgical approach, or pathologic anatomy. Intraoperative detection of injury to the thoracic duct or other lymphatics is even more challenging, especially if the patient’s anatomy is nonstandard. We describe a congenital heart disease patient with a preexisting pleural effusion that was administered an enteral slurry of methylene blue and 20% lipid emulsion intraoperatively to help delineate anatomy and detect chyle leakage. The slurry allowed for lymphatics visualization, but not thoracic duct identification.
{"title":"Enteral Administration of a Methylene Blue and 20% Lipid Emulsion Slurry to Aid in Diagnosis of Intraoperative Thoracic Duct Injury","authors":"Ali Hemyari MD , Allison B. Davila MD , Michael A. Evans MD, FAAP","doi":"10.1016/j.atssr.2025.06.016","DOIUrl":"10.1016/j.atssr.2025.06.016","url":null,"abstract":"<div><div>Thoracic duct identification during surgery in small children is often difficult or impossible secondary to patient size, surgical approach, or pathologic anatomy. Intraoperative detection of injury to the thoracic duct or other lymphatics is even more challenging, especially if the patient’s anatomy is nonstandard. We describe a congenital heart disease patient with a preexisting pleural effusion that was administered an enteral slurry of methylene blue and 20% lipid emulsion intraoperatively to help delineate anatomy and detect chyle leakage. The slurry allowed for lymphatics visualization, but not thoracic duct identification.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1097-1099"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-25DOI: 10.1016/j.atssr.2025.06.005
Amer Alzahrani MD, RRT , Mario Castro-Medina MD , Masashi Furukawa MD, PhD , Pablo G. Sanchez MD, PhD
Severe pectus excavatum and prior talc pleurodesis are traditionally considered relative contraindications to lung transplantation. A 36-year-old woman with idiopathic pulmonary fibrosis, pectus excavatum with a Haller Index of 6.7, and prior bilateral talc pleurodesis underwent successful bilateral lung transplantation. Chest closure was delayed due to right heart compression. On postoperative day 6, staged chest wall reconstruction with 2 Nuss bars was performed. She recovered without complications, was discharged on day 70, and remains off oxygen 910 days after transplant. With multidisciplinary planning and staged reconstruction, lung transplantation is feasible in select patients with complex chest wall pathology.
{"title":"Double-Lung Transplant With Delayed Nuss Bar Prostheses for Pectus Excavatum Deformity","authors":"Amer Alzahrani MD, RRT , Mario Castro-Medina MD , Masashi Furukawa MD, PhD , Pablo G. Sanchez MD, PhD","doi":"10.1016/j.atssr.2025.06.005","DOIUrl":"10.1016/j.atssr.2025.06.005","url":null,"abstract":"<div><div>Severe pectus excavatum and prior talc pleurodesis are traditionally considered relative contraindications to lung transplantation. A 36-year-old woman with idiopathic pulmonary fibrosis, pectus excavatum with a Haller Index of 6.7, and prior bilateral talc pleurodesis underwent successful bilateral lung transplantation. Chest closure was delayed due to right heart compression. On postoperative day 6, staged chest wall reconstruction with 2 Nuss bars was performed. She recovered without complications, was discharged on day 70, and remains off oxygen 910 days after transplant. With multidisciplinary planning and staged reconstruction, lung transplantation is feasible in select patients with complex chest wall pathology.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1120-1123"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-02-05DOI: 10.1016/j.atssr.2025.01.008
Yahya Alwatari MB , Mohamed Shanshal MB , Sameh Taki Aldin MD , Nate C. Johnson PharmD, RPh , Viengneesee Thao PhD , Bijan J. Borah PhD , K. Robert Shen MD
Background
As the therapeutic landscape evolves, we aim to evaluate the cost implications of National Comprehensive Cancer Network–recommended perioperative targeted/immunotherapies for non-small cell lung cancers (NSCLCs) and esophageal cancers.
Methods
The Medicare Part B payment allowance limits of treatment were ascertained. Using published data, we estimated the annual incidence of eligible patients. We applied the estimated cost of the medication based on treatment dosing and duration. The costs per patient and incident cohort were calculated.
Results
We estimated that 8602 patients with newly diagnosed esophageal cancers would be eligible for adjuvant nivolumab. The cost to treat 1 patient was $190,000, and the cost to treat 1 incident cohort was $1.6 billion. We estimated that 50,409 patients with NSCLC will meet the criteria for neoadjuvant nivolumab with a cost of 3 cycles of $32,000 per patient and $1.7 billion per cohort. Among NSCLC patients who may undergo resection and qualify for adjuvant therapy, 70,602 patients are anticipated to be epidermal growth factor receptor–negative and treated with adjuvant atezolizumab or pembrolizumab. Treatment costs range from $178,000 to $197,000 per patient, with up to $13.9 billion cost per cohort. The cost to treat 1 patient with adjuvant osimertinib was $556,000, with an incident cohort cost of $8 billion. The cost to treat an incident cohort of eligible thoracic malignancies is estimated at $25 billion.
Conclusions
Immune and targeted therapy in operable thoracic patients is associated with a significant cost burden. Studies are needed to assess cost-effectiveness to ensure optimal resource allocation and improve patient outcomes.
{"title":"Economic Impact of Targeted and Immunotherapies in Treating Operable Esophageal and Non-Small Cell Lung Cancers","authors":"Yahya Alwatari MB , Mohamed Shanshal MB , Sameh Taki Aldin MD , Nate C. Johnson PharmD, RPh , Viengneesee Thao PhD , Bijan J. Borah PhD , K. Robert Shen MD","doi":"10.1016/j.atssr.2025.01.008","DOIUrl":"10.1016/j.atssr.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>As the therapeutic landscape evolves, we aim to evaluate the cost implications of National Comprehensive Cancer Network–recommended perioperative targeted/immunotherapies for non-small cell lung cancers (NSCLCs) and esophageal cancers.</div></div><div><h3>Methods</h3><div>The Medicare Part B payment allowance limits of treatment were ascertained. Using published data, we estimated the annual incidence of eligible patients. We applied the estimated cost of the medication based on treatment dosing and duration. The costs per patient and incident cohort were calculated.</div></div><div><h3>Results</h3><div>We estimated that 8602 patients with newly diagnosed esophageal cancers would be eligible for adjuvant nivolumab. The cost to treat 1 patient was $190,000, and the cost to treat 1 incident cohort was $1.6 billion. We estimated that 50,409 patients with NSCLC will meet the criteria for neoadjuvant nivolumab with a cost of 3 cycles of $32,000 per patient and $1.7 billion per cohort. Among NSCLC patients who may undergo resection and qualify for adjuvant therapy, 70,602 patients are anticipated to be epidermal growth factor receptor–negative and treated with adjuvant atezolizumab or pembrolizumab. Treatment costs range from $178,000 to $197,000 per patient, with up to $13.9 billion cost per cohort. The cost to treat 1 patient with adjuvant osimertinib was $556,000, with an incident cohort cost of $8 billion. The cost to treat an incident cohort of eligible thoracic malignancies is estimated at $25 billion.</div></div><div><h3>Conclusions</h3><div>Immune and targeted therapy in operable thoracic patients is associated with a significant cost burden. Studies are needed to assess cost-effectiveness to ensure optimal resource allocation and improve patient outcomes.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1129-1134"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tube thoracostomy is one of the most important invasive procedures performed in many medical specialties for various indications.
Methods
A total of 13 experienced thoracic surgeons were asked to perform a single tube thoracostomy as a Bülau drain on a soft-embalmed human cadaver. The surgeons used a structured questionnaire with a modified Likert scale to rate the closeness to reality of the performed training on soft-preserved cadavers compared with standard performance on living patients. Two forms of soft embalming were available: Thiel’s, in 2 cadavers; and Dodge’s, in 2 cadavers. Six surgeons performed the procedure on Thiel embalmed cadavers, and the other 7 surgeons performed the procedure on Dodge embalmed cadavers.
Results
The evaluation of the results showed a high degree of closeness to reality and a 100% recommendation rate of the training for both forms of preservation. No significant differences could be found between Dodge embalmed cadavers and Thiel embalmed cadavers.
Conclusions
The use of soft-embalmed cadavers was rated very positively by experienced thoracic surgeons while performing tube thoracostomy. The evaluation results showed a high degree of realism of both embalming methods compared with performing the procedure on live patients. Further studies are needed to perform a competitive statistical analysis comparing Dodge embalmed cadavers and Thiel embalmed cadavers.
{"title":"Training of Tube Thoracostomy on Soft-Embalmed Cadavers According to Thiel and Dodge: What Do Experts Say?","authors":"Dariya Jaeger MD , Eric Hinrichs BBA , Volkan Kösek MD , Burkhard Thiel MD , Ludger Hillejan MD , Morris Beshay MD , Ralf Schoppe HE , Sven Schumann MD, PhD , Gebhard Reiss MD, PhD , Georg Feigl MD, PhD , Bassam Redwan MD, PhD","doi":"10.1016/j.atssr.2025.07.009","DOIUrl":"10.1016/j.atssr.2025.07.009","url":null,"abstract":"<div><h3>Background</h3><div>Tube thoracostomy is one of the most important invasive procedures performed in many medical specialties for various indications.</div></div><div><h3>Methods</h3><div>A total of 13 experienced thoracic surgeons were asked to perform a single tube thoracostomy as a Bülau drain on a soft-embalmed human cadaver. The surgeons used a structured questionnaire with a modified Likert scale to rate the closeness to reality of the performed training on soft-preserved cadavers compared with standard performance on living patients. Two forms of soft embalming were available: Thiel’s, in 2 cadavers; and Dodge’s, in 2 cadavers. Six surgeons performed the procedure on Thiel embalmed cadavers, and the other 7 surgeons performed the procedure on Dodge embalmed cadavers.</div></div><div><h3>Results</h3><div>The evaluation of the results showed a high degree of closeness to reality and a 100% recommendation rate of the training for both forms of preservation. No significant differences could be found between Dodge embalmed cadavers and Thiel embalmed cadavers.</div></div><div><h3>Conclusions</h3><div>The use of soft-embalmed cadavers was rated very positively by experienced thoracic surgeons while performing tube thoracostomy. The evaluation results showed a high degree of realism of both embalming methods compared with performing the procedure on live patients. Further studies are needed to perform a competitive statistical analysis comparing Dodge embalmed cadavers and Thiel embalmed cadavers.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1161-1165"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-06-23DOI: 10.1016/j.atssr.2025.06.002
Katherine Rand MD , Demetrios Mallios MD , Pierre Wong MD
An infant with an unrepaired ventricular septal defect (VSD) was found postmortem to have a unique VSD with anatomic features not previously described. Originally diagnosed as a perimembranous defect, autopsy revealed a tunnel-like channel with left ventricular origin inferior to the right coronary cusp, anterior to an intact membranous septum; an intramyocardial course posteroinferior to the pulmonary valve; and multiple right ventricular exit points superior to the anterior leaflet of the tricuspid valve. Accurate preoperative diagnosis is critical to guide surgical approach to this type of defect, which we term an intramyocardial VSD.
{"title":"A Novel Case of Intramyocardial Ventricular Septal Defect With Surgical Implications","authors":"Katherine Rand MD , Demetrios Mallios MD , Pierre Wong MD","doi":"10.1016/j.atssr.2025.06.002","DOIUrl":"10.1016/j.atssr.2025.06.002","url":null,"abstract":"<div><div>An infant with an unrepaired ventricular septal defect (VSD) was found postmortem to have a unique VSD with anatomic features not previously described. Originally diagnosed as a perimembranous defect, autopsy revealed a tunnel-like channel with left ventricular origin inferior to the right coronary cusp, anterior to an intact membranous septum; an intramyocardial course posteroinferior to the pulmonary valve; and multiple right ventricular exit points superior to the anterior leaflet of the tricuspid valve. Accurate preoperative diagnosis is critical to guide surgical approach to this type of defect, which we term an <em>intramyocardial VSD</em>.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1093-1096"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-07-09DOI: 10.1016/j.atssr.2025.06.008
Hrvoje Gasparovic MD, PhD , Maja Cikes MD, PhD , Kristina Krželj MD , Ivo Planinc MD, PhD , Maja Hrabak Paar MD, PhD
We present the case of a 34-year-old patient with an unresectable cardiac sarcoma who underwent a total cardiectomy followed by implantation of 2 HeartMate 3 devices in a total artificial heart configuration. Surgical treatment of cardiac sarcomas ranges from palliative debulking to heart transplantation. In contrast to conventional total artificial heart placement, complete removal of both atrioventricular connections was mandated by the underlying pathologic process. Hemodynamic performance of 2 continuous flow pumps in the absence of native atria and the heart reservoir function depends on balancing preload, afterload, and individual pump rotations. The unreliability of conventional monitoring parameters in this clinical scenario makes hemodynamic management challenging.
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Residual lobar shifting after lobectomy promotes effective lung expansion and occasionally better-than-expected preservation of pulmonary function. Our previous study found that patients with lobar shifting (shift group) exhibited considerably better preservation of forced expiratory volume in 1 second (FEV1) than those without it (nonshift group). During left upper lobectomy, however, no significant difference in FEV1 preservation was noted between the groups, although our results tended to favor the nonshift group. Although segmentectomy is generally better at preserving pulmonary function than lobectomy, lobar shifting after lobectomy may alter outcomes. This study aimed to identify which segmentectomy sites better preserve pulmonary function compared with lobectomy while considering lobar shifting.
Methods
We analyzed 324 segmentectomies and 839 lobectomies from 2012 to 2024, excluding middle lobe resections. Lobar shifting, evaluated using 3-dimensional computed tomography 6 months after surgery, was categorized based on middle lobe, lingular, and left lower lobe bronchus displacement. Pulmonary function tests were conducted before and 6 months after surgery. FEV1, vital capacity, and forced vital capacity preservation rates between the segmentectomy and shift or nonshift groups were compared according to resection site.
Results
Significant differences in FEV1 preservation between lobectomy and segmentectomy were observed only for right S2 (P < .001) and left S1 + 2 (P = .002), with both regions also showing significant differences in vital capacity and forced vital capacity.
Conclusions
Even under conditions favorable for preserving pulmonary function after lobectomy considering lobar shifting, segmentectomy of right S2 and left S1+2 resulted in better postoperative function.
{"title":"Efficacy of Right S2 and Left S1+2 Segmentectomy: Comparison of Pulmonary Function With Lobectomy","authors":"Sanae Kuroda MD , Nahoko Shimizu MD, PhD , Megumi Nishikubo MD , Yuki Nishioka MD , Wataru Nishio MD, PhD","doi":"10.1016/j.atssr.2025.06.011","DOIUrl":"10.1016/j.atssr.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Residual lobar shifting after lobectomy promotes effective lung expansion and occasionally better-than-expected preservation of pulmonary function. Our previous study found that patients with lobar shifting (shift group) exhibited considerably better preservation of forced expiratory volume in 1 second (FEV<sub>1</sub>) than those without it (nonshift group). During left upper lobectomy, however, no significant difference in FEV<sub>1</sub> preservation was noted between the groups, although our results tended to favor the nonshift group. Although segmentectomy is generally better at preserving pulmonary function than lobectomy, lobar shifting after lobectomy may alter outcomes. This study aimed to identify which segmentectomy sites better preserve pulmonary function compared with lobectomy while considering lobar shifting.</div></div><div><h3>Methods</h3><div>We analyzed 324 segmentectomies and 839 lobectomies from 2012 to 2024, excluding middle lobe resections. Lobar shifting, evaluated using 3-dimensional computed tomography 6 months after surgery, was categorized based on middle lobe, lingular, and left lower lobe bronchus displacement. Pulmonary function tests were conducted before and 6 months after surgery. FEV<sub>1</sub>, vital capacity, and forced vital capacity preservation rates between the segmentectomy and shift or nonshift groups were compared according to resection site.</div></div><div><h3>Results</h3><div>Significant differences in FEV<sub>1</sub> preservation between lobectomy and segmentectomy were observed only for right S2 (<em>P</em> < .001) and left S1 + 2 (<em>P</em> = .002), with both regions also showing significant differences in vital capacity and forced vital capacity.</div></div><div><h3>Conclusions</h3><div>Even under conditions favorable for preserving pulmonary function after lobectomy considering lobar shifting, segmentectomy of right S2 and left S1+2 resulted in better postoperative function.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 861-866"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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