Video-Assisted Thoracic Surgery Rib Resection and Reconstruction With Titanium Plate

Rib resection using a Gigli saw under thoracoscopic guidance

Introduction

Despite the advantages and expanded indications of video-assisted thoracoscopic surgery, the open surgical approach is commonly preferred for the surgical treatment of rib lesions. Such an approach could lead to disadvantageous results such as increased postoperative pain and prolonged hospital stay. Despite all these handicaps, thoracoscopic resection of isolated rib resection has been reported in a small number of publications.

Aim

To compare the clinical outcomes of patients with isolated benign rib pathologies treated with either minimally invasive or open surgery.

Material and methods

The medical records of 22 patients undergoing surgery for isolated benign rib pathologies between 2013 and 2017 were reviewed. Variables statistically compared between the two groups were age, gender, symptoms, lesion size, duration of the surgery, amount of intraoperative bleeding, conversion to open surgery, volume and duration of the drainage, postoperative complications, length of hospital stay, pathological diagnosis, follow-up period, recurrence, duration of narcotic analgesic usage and pain according to visual analog scale evaluation.

Results

The thoracoscopic approach was superior to conventional surgery in terms of drainage volume, time to drain removal, morbidity, hospital stay, narcotic analgesic treatment duration and postoperative pain scores. All thoracoscopic procedures were concluded successfully, and conversion to open surgery was not required. During the mean 14-month follow-up period, no recurrence was encountered in either group.

Conclusions

This technique is a safe option for isolated benign lesions of the ribs. It is more effective in patient recovery in the postoperative period and in the management of surgical pain.

Video-assisted thoracoscopic surgery lobectomy with chest wall resection

Lung cancer presents with chest wall invasion in 5-8% of patients, which imparts some treatment challenges. Surgical resection is currently the standard of care, and there are some controversies regarding the best approach. Published series and case reports confirm the safety and feasibility of video-assisted thoracoscopic surgery (VATS) in highly complex surgical cases including lobectomy with chest wall resection of locally advanced lung cancer. In this article, we present the clinical indications of locally advanced lung cancer that infiltrates the chest wall, the modalities for and importance of accurately staging lung cancers with chest wall invasion, and the technical aspects of accomplishing a safe and oncologically sound extended resection through VATS.

Video-assisted thoracoscopic surgery en bloc chest wall resection

In the latest two decades, the video-assisted thoracoscopic surgery (VATS) technique has gained recognition as an effective alternative to conventional open surgery, and the field of its application has gradually extended to more complex diseases, such as locally invasive non-small cell lung cancer (NSCLC) requiring combined lung and chest wall resection. The en bloc chest wall resection can be accomplished by using a typical VATS port placement, each time adjusted to allow a better thoracoscopic guidance and a correct resection of the tumour to achieve negative margins. Different approaches have been described by experienced surgeons, with a remarkable variability in the number and disposition of the ports, in the surgical tools used and in the strategy of sparing the covering tissues. The common denominator of these experiences is the aim of extending the criteria of functional and oncological operability to high-risk patients who are not suitable for a conventional thoracotomy. Indeed, the VATS approach has shown effectiveness in reaching unchanged oncological outcomes in comparison with the thoracotomic technique but involving significantly less postoperative pain, faster recovery, shorter hospitalisation and lower overall complications.

Technique of video-assisted thoracoscopic left pneumonectomy

Video-assisted thoracoscopic surgery (VATS) approaches to lobectomy for treatment of early stage non-small cell lung cancer (NSCLC) have generally been accepted to be beneficial. Experience and results for more extensive resections, including thoracoscopic pneumonectomy are limited. Here we report a case with attached videos describing key technical aspects of performing a thoracoscopic left pneumonectomy. This demonstrates the adoption of VATS for tumor pathology requiring pneumonectomy is feasible and can be done safely. Further study is needed to clarify potential advantages or drawbacks to approaching more complex tumor pathology by VATS.

[Place of the microscopic examination in the diagnosis of costal fibrous dysplasia]

BACKGROUND

Fibrous dysplasia of bone is a rare benign lesion characterized by the coexistence of a fibrous tissue and an immature osteogenesis. Costal localization is rare and may be monostotic or polyostotic. The diagnosis may be suspected based on clinical and radiological findings. Facing the development of radiological investigations, we tried to highlight the diagnostic role of the microscopic examination through the experience of our department.

METHODS

We describe a retrospective study about 12 costal fibrous dysplasias diagnosed over a 17-year-period. Clinical records were retrieved from the department of thoracic surgery of the same hospital.

RESULTS

Costal fibrous dysplasia is equally observed in men and women with predominance in the third and fourth decades. Clinical symptoms consist mainly in chest pain. Physical examination was normal in almost all cases. Based on the radiological findings, the diagnosis was suspected in 33% of the cases. Microscopic examination highlighted the diagnosis in all cases but it was challenging in one case and necessitated a multi-disciplinary approach. The difficulties encountered were due to artifact decalcification.

CONCLUSION

Costal fibrous dysplasia is a benign lesion which diagnosis is based on microscopic features. Radiologic investigations show nonspecific features but allow to rule out a malignant tumor. The outcome of the patients is generally good except in rare cases with a malignant transformation.

[Complete Single-Utility-Port Thoracoscopic Resection of Lung Cancer with Single-Rib Metastasis]

背景与目的

随着全胸腔镜手术经验的增加，其适应症也在向复杂的术式延伸。本研究旨在探讨单操作孔全胸腔镜下同期行肺叶联合肋骨切除术的可行性。

方法

结合我科为1例肺癌单发肋骨转移的患者进行了“单操作孔全胸腔镜下肺叶及部分肋骨切除术”进行病例分享并复习有关文献。

结果

肿瘤分期为T1N1M1。患者术后恢复良好并于术后第4天出院。最近一次随访于术后18个月，患者无病生存良好。

结论

筛选后的肺癌伴肋骨转移病例，适合行单操作孔全胸腔镜手术切除。

Resection of a bony tumour of the chest wall with direct reconstruction using a sandwich technique: a standard technique for closure of large chest wall defects

Bony tumours of the chest wall are rare and radical surgical resection forms the cornerstone of treatment. Closure of the defect following radical resection can be challenging. We report the case of a 59-year-old woman with a large tumour of the thoracic wall, which was surgically resected with direct reconstruction using a sandwich technique with a Palacos^® patch placed in a double-layer Marlex mesh. Pathological examination showed a fibrous dysplasia of the rib. The patient had a good functional and cosmetic result.

Single-port thoracoscopic rib resection: a case report

We describe a method of single-port thoracoscopic rib resection using a Gigli saw. Rib resection is typically performed with a large skin incision and soft tissue dissection. Some authors have described a thoracoscopic approach for rib resection from the inner side of the chest wall instead of the outside to decrease pain and improve quality of life. A 41-year-old Chinese male received single-port thoracoscopic rib resection with satisfactory recovery. We present the technique, which may expand the indications of single-port thoracoscopic procedures.

Chest wall resection and reconstruction according to the principles of biomimesis

Biomimesis has become the objective of the reconstructive strategies after chest wall resections for primary or secondary tumors. Biomimesis is pursued by respecting the anatomy, preserving function, selecting adequate reconstructive materials, and integrating multidisciplinary efforts for complex reconstructions. Elements of novelty in the clinical practice are represented by the introduction of the principles of video-assisted thoracic surgery to resect chest wall tumors and the increasingly frequent resort to either new materials or revised concepts of time-honored ones for chest wall reconstruction. Experimental investigation seems to outline interesting perspectives for materials destined to reconstruction after either partial or full-thickness resections for recurrent chest wall tumors.