Video-Assisted Thoracic Surgery最新文献

{"title":"Robotic hilum-mediastinal lymph nodes dissection for operable non-small cell lung cancer (NSCLC) patients: state of art","authors":"F. Gallina, G. Alessandrini, F. Facciolo","doi":"10.21037/vats-21-18","DOIUrl":"https://doi.org/10.21037/vats-21-18","url":null,"abstract":"In the last few years, minimally invasive thoracic surgical techniques were strongly improved enough to become part of daily lung cancer surgical treatment. Although the minimally invasive lobectomy techniques were well-established, controversial still remain about the lymphadenectomy. The first studies about the video-assisted thoracoscopic surgery (VATS) reported better perioperative outcomes compared to thoracotomy but the long-term efficacy is uncertain. The robotic approach represents a technological evolution of VATS procedure that leads to some technical advantages derived from the wide angle of maneuverability of the instruments, which is even superior to that of the human hand. Overall survival after surgery for pN0 non-small cell lung cancer is associated with a higher numbers of lymph nodes resected. This achieves a more accurate staging and a quick starting of the postoperative treatments if needed. Previous studies reported that there are differences in terms of lymphadenectomy with VATS compared to thoracotomy. The thoracoscopic approach showed a lower rate of nodal upstaging. In this review we analyzed the principal technical aspects of the mediastinal lymph nodes dissection and we reported the principal studies that are conducted about the postoperative nodal upstaging following the minimally invasive lung cancer surgery. The results showed that the robotic approach allows to achieve a more accurate lymphadenectomy compared to VATS with a higher number of nodal upstaging. The consequence of this would be that the postoperative oncological treatment can be set faster and more accurately.","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":"44959999","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":"Literature review: non-intubated (tubeless) VATS for lung volume reduction surgery","authors":"Yi Zhang, Xin Jin","doi":"10.21037/vats-21-23","DOIUrl":"https://doi.org/10.21037/vats-21-23","url":null,"abstract":"The non-intubated video-assisted thoracoscopic surgery (NI-VATS) is developed from traditional video-assisted thoracoscopic surgery (VATS). In NI-VATS, deep anesthesia is avoided, and a face or laryngeal is used instead of ordinary tracheal intubation. Patients usually have fewer complaints of postoperative discomfort and recover faster by this method. Since the first report of NI-VATS wedge resection, surgical teams from all over the world have enlarged the range of non-intubation to almost all kinds of VATS treatments, such as mediastinal tumor resection (1), carinal reconstruction (2), and lobectomy (3). Lung volume reduction surgery (LVRS) is taken as an interventional therapy for severe emphysema caused by chronic obstructive pulmonary disease (COPD), smoking, or other factors. In LVRS, the damaged emphysematous upper lobe tissue is resected, in which the expiratory airway collapses, gas traps severely, and the alveolus is over-inflated. Then the remaining lung expands, and the patient’s symptoms like shortness of breath or dyspnea may improve (4,5). Objective: To describe the reproducible surgical and anesthesia techniques of lung volume reduction surgery (LVRS) under non-intubation. In addition, the advantages of modified non-intubated unilateral LVRS are also introduced in this article. Background: The perioperative complications and unsatisfied mortality of the typical LVRS under general anesthesia hinder the popularity of the surgery. In recent years, the concept of non-intubation has been introduced to LVRS. However, the reports and researches in this field are not so common. Methods: We searched current literature related to LVRS and non-intubated LVRS of recent 20 years in PubMed and compared different resection ranges and methods of LVRS under non-intubation. Conclusions: Our group reviewed the current papers in this field and found that the poor lung quality (and cardiac function in some cases) of the target patient is not the absolute contradiction to adopting the non-intubation anesthesia technique in LVRS. On the contrary, the non-intubated LVRS may be even safer and bring more benefits than the traditional operation method among selected patients. Furthermore, the modified non-intubated unilateral LVRS can reduce perioperative complications by comparing to the traditional bilateral LVRS. The LVRS on the opposite side is unnecessary if no significant progression is found by regular follow-up. In summary, the surgical team can make an attempt to non-intubation in LVRS after thorough evaluation.","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":"42794730","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":"Indication of uniportal video-assisted thoracoscopic surgery","authors":"K. Hirai, J. Usuda","doi":"10.21037/vats-20-40","DOIUrl":"https://doi.org/10.21037/vats-20-40","url":null,"abstract":": Uniportal video-assisted thoracoscopic surgery (U-VATS) has been recognized as a one of minimally invasive surgery among thoracic surgeons. For some diseases such as some benign inflammatory diseases, mediastinal tumor, metastatic lung tumor, and lung cancer in thoracic surgery, U-VATS has already been applied. There is no definite indication of U-VATS even in lung cancer. According to the surgeon’s ability at the institute, indication of U-VATS for the lesion that is benign or malignant is determined at this moment. The clarification of indication of U-VATS is also essential for doing safe surgery. On the other hand, prognosis of U-VATS anatomical lung resection for early lung cancer remains still unclear in detail. Recently, U-VATS has been started to perform even in advanced lung cancer. In spite of the vague surgical outcomes of U-VATS, it is certain that indication of U-VATS has gradually expanded. Oncologically, there is a room to argue on U-VATS anatomical lung resection for lung cancer still more. Additionally, the application of U-VATS for advanced lung cancer possesses a little unreliable due to possibility of incomplete lymph node dissection. Because the unfavorable outcomes for the patients with lung cancer such as local recurrence and severe troubles during surgery causes, the clarification of indication of U-VATS is an urgent issue. Based on our experience, we reviewed the indication of U-VATS for lung cancer.","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":"42804172","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":"Risk prediction for lung cancer surgery in the current era","authors":"M. Taylor, G. Whittaker, S. Grant, R. Booton, R. Shah","doi":"10.21037/vats-21-47","DOIUrl":"https://doi.org/10.21037/vats-21-47","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":"46881476","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":"Mediastinal up-staging: risk factors and prognosis: a narrative review","authors":"D. Nachira, M. Chiappetta, E. Zanfrini, E. Meacci, M. Congedo, F. Lococo, M. Vita, L. Petracca-Ciavarella, D. Tabacco, C. Sassorossi, V. Porziella, S. Margaritora","doi":"10.21037/vats-21-24","DOIUrl":"https://doi.org/10.21037/vats-21-24","url":null,"abstract":"Mediastinal nodal upstaging after surgical resection for nonsmall cell lung cancer (NSCLC) is defined as the finding of mediastinal node disease (pN2) at pathological staging in presumed clinical N0-1 tumors (1,2). Pathological mediastinal lymph node involvement is one of the most important prognostic factors in NSCLC and the main determinant for adjuvant therapy after surgery. The aim of this review is to analyze the principal risk factors for mediastinal nodal upstaging and to evaluate the prognostic implications for patients affected by NSCLC. 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":"45643185","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":"Role and evidence for targeted therapies in surgically resectable non-small cell lung cancer: a narrative review","authors":"C. Escriu","doi":"10.21037/vats-21-39","DOIUrl":"https://doi.org/10.21037/vats-21-39","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":"48774592","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":"A narrative review of paraconduit hernia after esophagectomy: where are we now?","authors":"J. R. Mondoñedo, A. Chang","doi":"10.21037/vats-21-28","DOIUrl":"https://doi.org/10.21037/vats-21-28","url":null,"abstract":"Objective: To discuss potential mechanisms and risk factors for the rise in incidence with MIE techniques as well as examine recent data supporting indications and techniques for repair of paraesophageal hernias. Background: Esophagectomy is the standard of care for surgically resectable esophageal cancers. Recent advances in minimally invasive esophagectomy (MIE) and hybrid techniques over the past several years have provided less morbid, oncologic equivalent strategies as compared with traditional open abdominal or transthoracic approaches. While this has generally led to improved patient outcomes, there has been a commensurate rise in the incidence of paraesophageal hernias, a known complication that is likely secondary to iatrogenic widening and instrumentation of the hiatus. Currently, indications and timing for repair of paraconduit hernias remain disputed. Methods: We performed a literature review of reports describing the incidence rate, operative techniques, and recent advances in the diagnosis and management of paraconduit hernias over the past decade. Conclusions: Incidence rates appear to be highest for the MIE transthoracic Ivor Lewis approach, although the increasingly utilized transhiatal robot-assisted esophagectomy may be associated with similar rates of hernia occurrence. Surveillance is a reasonable option for patients without symptoms, especially those with limited life expectancy given the nontrivial morbidity and recurrence rates after repair; however, laparoscopic surgical repair should be considered for symptomatic patients given the risk of rapid progression and subsequent perforation. Future work should examine surgical techniques for prevention of post-esophagectomy hernia.","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":"43460055","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":"A narrative review on lymphadenectomy: from open to minimally invasive surgery","authors":"V. Aprile, Ilaria Ceccarelli, S. Korasidis, M. G. Mastromarino, D. Bacchin, E. Sicolo, M. Ambrogi, M. Lucchi","doi":"10.21037/vats-21-33","DOIUrl":"https://doi.org/10.21037/vats-21-33","url":null,"abstract":"Lymphadenectomy plays a crucial role during surgical treatment for lung cancer and represents a cornerstone to assess staging and prognosis since lymph-nodes (LN) involvement is an important factor to define post-operative strategies and to predict oncological outcomes [namely overall survival (OS) and disease-free interval] (1,2). According to the 8th TNM edition of non-small cell lung 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":"42760851","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":"Searching for evidence of VATS lung metastasectomy","authors":"M. Migliore, Michel Gonzalez","doi":"10.21037/VATS-2020-LM-10","DOIUrl":"https://doi.org/10.21037/VATS-2020-LM-10","url":null,"abstract":"We are pleased to introduce this issue devoted to video-assisted thoracic surgery (VATS) for lung metastases. Although not confirmed with prospective randomized trials, pulmonary resection(s) is the operation of choice for lung metastases with a relatively low postoperative complication rate. Nonetheless, the surgical approach to perform lung metastasectomy remains a point of debate as VATS or open transthoracic approach can both be performed. Though surgeons are looking for reliable data in favor of VATS for lung metastasectomy, there is scarce prospective data and most available practices raise questions (1) instead of giving answers. Nevertheless, after 10 years of ESTS project dedicated to lung metastases (2), this special issue dedicated to VATS metastasectomy, which also includes exceptional videos, will help to publicize important experiences, and will also stimulate young surgeons, oncologists and scientists to find new ideas for the future. There will also be an article which reports on the TNM classification for lung metastases which we initially proposed in 2016 (3). It could be an easy way to finally “personalize” the treatment of the difficult patients with lung metastases (4). One thing is certain, in the absence of scientific evidence that demonstrates that one approach (open or VATS) is better than the other, the less invasive approach should be chosen. Therefore, there is no doubt that VATS (uniportal, multiportal or subxiphoid) represents nowadays the most used “standard practice” to remove lung metastases. Nevertheless, surgeons should never forget that the fundamental goal of the procedure of lung metastasectomy is not the minimal invasiveness of the skin incision but the prolonged survival. We are in debt of gratefulness to the outstanding contributors for offering their knowledge and practice with lung metastasectomy. Finally, we would like to acknowledge Video-Assisted Thoracic Surgery (VATS) journal for allowing us organize this important special issue and for the exceptional work done by all the staff.","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":"49396022","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":"Influence of mentorship on the duration and safety of robotic learning curve for anatomical lung resections","authors":"M. Gómez-Hernández, M. Jiménez","doi":"10.21037/vats-21-38","DOIUrl":"https://doi.org/10.21037/vats-21-38","url":null,"abstract":"The introduction of the surgical robotic system in 2000 supposed a major advancement in minimally invasive surgery and has become a disruptive technology in surgical practice (1,2). However, the adoption of new technologies such as robotics by practicing surgeons involves an unavoidable learning curve (3). Moreover, there is a belief that learning curves may have a negative impact on patient Original 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":"44670472","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}