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Cangut B, Mitchell KG, Antonoff MB. The 7 Pillars of Training Minimally Invasive Thoracic Surgery: Embracing the Virtual Era. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:414-418. [PMID: 37743743 DOI: 10.1177/15569845231201165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Affiliation(s)
- Busra Cangut
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Kyle G Mitchell
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Grossi W, Londero F, Vit A, De Franceschi E, Masullo G, Sponza M, Morelli A. Hybrid minimally invasive treatment of intralobar pulmonary sequestration: a single-centre experience. Interact Cardiovasc Thorac Surg 2022; 34:255-257. [PMID: 34480559 PMCID: PMC8766203 DOI: 10.1093/icvts/ivab245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 12/03/2022] Open
Abstract
Pulmonary sequestrations are rare congenital malformations. They are often located in the lower lobes, and they are supplied by an aberrant systemic vessel arising from the thoracic aorta or abdominal arteries. These pulmonary malformations are divided into intra- and extralobar sequestrations, depending on the respective lack or presence of an independent pleural covering. Pulmonary sequestration can be asymptomatic or lead to recurrent pulmonary infections. The goal of this study was to analyse the feasibility and safety of a hybrid sequential approach. We report a small series of intralobar pulmonary sequestrations, from November 2017 to December 2018, successfully treated with a hybrid minimally invasive approach consisting of endovascular embolization of the aberrant arterial branch followed by video-assisted thoracoscopic lobectomy the day after. Thoracic pain following endovascular embolization was noted in all cases. Patients were discharged early in the absence of major postoperative complications. Prolonged air leak was observed in only 1 case. Despite the presence of sequestration-related pulmonary inflammation, in our experience, hybrid treatment for intralobar pulmonary sequestration is a safe and reproducible approach in terms of postoperative complications and hospital stay.
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Affiliation(s)
- William Grossi
- Department of Cardiothoracic Surgery, Thoracic Surgery Unit, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Francesco Londero
- Department of Cardiothoracic Surgery, Thoracic Surgery Unit, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Alessandro Vit
- Department of Radiology, Interventional Radiology Unit, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Elisa De Franceschi
- Department of Cardiothoracic Surgery, Thoracic Surgery Unit, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Gianluca Masullo
- Department of Cardiothoracic Surgery, Thoracic Surgery Unit, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Massimo Sponza
- Department of Radiology, Interventional Radiology Unit, Santa Maria della Misericordia Hospital, Udine, Italy
| | - Angelo Morelli
- Department of Cardiothoracic Surgery, Thoracic Surgery Unit, Santa Maria della Misericordia Hospital, Udine, Italy
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Rosenfeld ES, Napolitano MA, Sparks AD, Werba G, Antevil JL, Trachiotis GD. Impact of Trainee Involvement on Video-Assisted Thoracoscopic Lobectomy for Cancer. Ann Thorac Surg 2021; 112:1855-1861. [PMID: 33358890 DOI: 10.1016/j.athoracsur.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/20/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Previous literature in other surgical disciplines regarding the impact of resident and fellow involvement on operative time and outcomes has yielded mixed results. The impact of trainee involvement on minimally invasive thoracic surgery is unknown. This study compared risk-adjusted differences in operative time and outcomes of video-assisted thoracoscopic lobectomy for cancer between cases performed with and without residents and fellows involved. METHODS All patients undergoing elective video-assisted thoracoscopic lobectomy for cancer between 2008 and 2018 were identified in the Veterans Affairs Surgical Quality Improvement Program database. Patients were stratified into 2 cohorts: cases with residents and fellows involved, and cases performed only by attending surgeons. Primary outcomes included operative time, postoperative hospital length of stay, and composite 30-day morbidity and mortality. Secondary outcomes included factors associated with high and low trainee operative autonomy. RESULTS A total of 3678 patients met study inclusion criteria. In all, 1780 cases were performed with residents and fellows involved (median postgraduate year, 5; interquartile range, 4-7). Multivariate analysis showed that operative time was significantly shorter in resident- and fellow-involved cases compared with attending-only cases (mean [SD], 3.6 [1.4] versus 3.8 [1.6] hours; P < .001). There were no significant differences in composite 30-day morbidity and mortality (16.0% versus 17.1%; adjusted odds ratio = 0.93; 95% confidence interval, 0.77-1.11; P = .40) or length of stay. Substratification of trainees by postgraduate year resulted in similar findings. Cases performed in July through October and those in the Northeastern United States were associated with low autonomy. CONCLUSIONS Current training paradigms in thoracic surgery are safe, and the involvement of motivated and skilled trainees with appropriate supervision may benefit operative duration.
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Affiliation(s)
- Ethan S Rosenfeld
- Division of Cardiothoracic Surgery and Heart Center, Washington, DC Veterans Affairs Medical Center, Washington, DC; Department of Surgery, George Washington University, Washington, DC
| | - Michael A Napolitano
- Division of Cardiothoracic Surgery and Heart Center, Washington, DC Veterans Affairs Medical Center, Washington, DC; Department of Surgery, George Washington University, Washington, DC
| | - Andrew D Sparks
- Department of Surgery, George Washington University, Washington, DC
| | - Gregor Werba
- Department of Surgery, George Washington University, Washington, DC
| | - Jared L Antevil
- Division of Cardiothoracic Surgery and Heart Center, Washington, DC Veterans Affairs Medical Center, Washington, DC
| | - Gregory D Trachiotis
- Division of Cardiothoracic Surgery and Heart Center, Washington, DC Veterans Affairs Medical Center, Washington, DC; Department of Surgery, George Washington University, Washington, DC.
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Balta C, Kuzucuoğlu M, Can Karacaoglu I. Evaluation of YouTube Videos in Video-Assisted Thoracoscopic Pulmonary Lobectomy Education. J Laparoendosc Adv Surg Tech A 2020; 30:1223-1230. [DOI: 10.1089/lap.2020.0140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Cenk Balta
- Department of Thoracic Surgery, Balıkesir University Health Application and Research Hospital, Balıkesir, Turkey
| | - Mustafa Kuzucuoğlu
- Department of Thoracic Surgery, İzmir Katip Çelebi University Health Application and Research Hospital, İzmir, Turkey
| | - Ismail Can Karacaoglu
- Department of Thoracic Surgery, Van State Health Application and Research Hospital, Van, Turkey
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Elkhouly AG, Sorge R, Rogliani P, Cristino B, Wahby E, Serag A, Liang H, He J, Pompeo E. Ergonomical Assessment of Three-Dimensional Versus Two-Dimensional Thoracoscopic Lobectomy. Semin Thorac Cardiovasc Surg 2020; 32:1089-1096. [PMID: 32450215 DOI: 10.1053/j.semtcvs.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 11/11/2022]
Abstract
In this study. we compared ergonomical domains characteristics of three-dimensional (3D) versus two-dimensional (2D) video-systems in thoracoscopic lobectomy using a scoring-scale-based assessment. Seventy patients (mean age, 69 ± 6.9 years, 43 males and 27 females) with early stage lung cancer were randomized to undergo thoracoscopic lobectomy by either 3D (N = 35) or 2D (N = 35) video-systems. All operations were divided into 5 standardized surgical steps (vein, artery, bronchus, fissure, and lymph nodes), which were evaluated by 4 thoracic surgeons using a scoring scale (score range from 1, unsatisfactory to 3,excellent) entailing assessment of 3 ergonomical domains: exposure, instrumentation and maneuvering. Primary outcome was a difference ≥10% in the maneuvering domain steps. At intergroup comparisons, there was no difference in demographics. The 3D system results were better for maneuvering domain total score and particularly for the artery and bronchus steps scores (score ≥10%, P ≤ 0.006). Other significant differences included exposure of the vein, artery and bronchus (P ≤ 0.03). Results favoring the 2D system included maneuvering, exposure and instrumentation of the fissure (P = 0.001). Inter-rater concordance of ergonomics scoring was satisfactory (Cronbach's α range, 0.85-0.88). Operative time was significantly shorter in the 3D group (127 ± 19 min vs 143±18 min, P = 0.001) whereas there was no difference in hospital stay (3.4 ± 1.2 vs 4.1 ± 1.6 days, P = 0.07). In this study comparison of ergonomic domains scoring in 3D versus 2D thoracoscopic lobectomy favored the 3D system for the maneuvering total score, which proved inversely correlated with operative times possibly due to a better perception of depth and more precise surgical maneuvering.
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Affiliation(s)
- Ahmed G Elkhouly
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Roberto Sorge
- Department of Biostatistics, Policlinico Tor Vergata University, Rome, Italy
| | - Paola Rogliani
- Department of Respiratory Medicine, Policlinico Tor Vergata University, Rome, Italy
| | - Benedetto Cristino
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy
| | - Ehab Wahby
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Amro Serag
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Hengrui Liang
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Jianxing He
- Department of Thoracic Surgery and Oncology, the First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, China
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy.
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Miyazaki T, Imperatori A, Jimenez M, Drosos P, Gomez-Hernandez MT, Varela G, Novoa N, Nagayasu T, Brunelli A. An aggregate score to stratify the technical complexity of video-assisted thoracoscopic lobectomy. Interact Cardiovasc Thorac Surg 2019; 28:728-734. [PMID: 30500910 DOI: 10.1093/icvts/ivy319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/03/2018] [Accepted: 10/14/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to develop a score to predict the complexity of video-assisted thoracoscopic surgery (VATS) lobectomies preoperatively. METHODS One hundred and thirty-nine consecutive patients undergoing VATS lobectomy operated on by a single surgeon as the first operator were included. Complex operations were defined as: operation time >180 min (corresponding to the 75th percentile) or a conversion to thoracotomy. Several patient-related baseline and radiological variables were tested for a possible association with surgical complexity by logistic regression analysis. An aggregate score was created by weighing the regression estimates of the significant predictors. Patients were then grouped in classes of risk according to their scores. Finally, the score was validated in an external population of 154 VATS lobectomy patients. RESULTS Twenty-nine VATS lobectomies (21%) were classified as complex. The following variables were found to be significantly associated with a complex operation and were used to calculate the risk score in each patient (1 point each): male (P = 0.006), presence of thick pleura (P = 0.003), presence of emphysema (P = 0.001), enlarged hilar nodes (P = 0.003). Patients were grouped in 4 classes showing an incremental incidence of complex operations (P < 0.0001): score 0, 7.4%; score 1, 18%; score 2, 27%; score >2, 67%. In the external validation set, the score confirmed its association with the incidence of complex operations (P < 0.001): score 0, 7.3%; score 1, 10%; score 2, 16%; score >2 50%. CONCLUSIONS The complexity score appeared to be reproducible in an external setting and can be used to preoperatively identify appropriate candidates for VATS lobectomies to improve the efficiency and safety of the training phase.
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Affiliation(s)
- Takuro Miyazaki
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Andrea Imperatori
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marcelo Jimenez
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Polivios Drosos
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Gonzalo Varela
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Nuria Novoa
- Department of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Alessandro Brunelli
- Department of Thoracic Surgery, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Nosotti M. Video-assisted thoracic surgery (VATS) lobectomy: a matter of competence. J Thorac Dis 2018; 10:S2190-S2191. [PMID: 30123557 DOI: 10.21037/jtd.2018.06.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mario Nosotti
- U.O. Chirurgia Toracica e Trapianti di Polmoni, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
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Hirji SA, Balderson SS, D'Amico TA. Uniportal lobectomy and segmentectomy-is it for all? J Vis Surg 2018; 3:180. [PMID: 29302456 DOI: 10.21037/jovs.2017.11.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/22/2017] [Indexed: 11/06/2022]
Abstract
Technological advances have markedly transformed the philosophy of thoracic surgery in the current era, with notable improvements in patient outcomes with video-assisted thoracoscopic surgery (VATS). More recently, innovations in uniportal VATS approaches have been promising, although robust data on their efficacy is limited. Nonetheless, the lessons learned from experience with the 2-port and 3-port VATS lobectomy and segmentectomy can be applied to further improve the efficacy of uniportal approaches, in terms of achieving oncologic efficacy and improving patient outcomes. This perspective reviews contemporary outcomes of uniportal lobectomy and segmentectomy, highlights our institutional experience, and examines future directions and challenges pertaining to widespread adoption of this innovative technique.
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Affiliation(s)
- Sameer A Hirji
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Thomas A D'Amico
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Invited Commentary. Ann Thorac Surg 2017; 103:460-461. [PMID: 28109349 DOI: 10.1016/j.athoracsur.2016.08.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 08/28/2016] [Accepted: 08/31/2016] [Indexed: 11/21/2022]
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Abstract
Turkey with a population of 78 million is located between Asia and Europe geographically and culturally. There are 577 active pure thoracic surgeon and 37 thoracic surgery teaching units. Thoracic surgeons usually deal with lung cancer patients due to relatively higher rate of tobacco usage as well as inflammatory diseases such as pulmonary hydatid disease, bronchiectasis and empyema. Minimally invasive thoracic surgery has been a new approach which is being adapted by increasingly more surgeons. There are a number of reasons to predict that the number of thoracic surgical cases will be increased and new generation of thoracic surgeons will be operating more minimally invasive resectional surgeries for most lung cancer in future.
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Affiliation(s)
- Akif Turna
- Department of Thoracic Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
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Training for Thoracoscopic Lobectomy. Ann Thorac Surg 2016; 102:1032. [PMID: 27549535 DOI: 10.1016/j.athoracsur.2016.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 03/11/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022]
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Vannucci F, Gonzalez-Rivas D. Is VATS lobectomy standard of care for operable non-small cell lung cancer? Lung Cancer 2016; 100:114-119. [PMID: 27597290 DOI: 10.1016/j.lungcan.2016.08.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 08/04/2016] [Accepted: 08/10/2016] [Indexed: 11/26/2022]
Abstract
Video-Assisted Thoracic Surgery (VATS) for treatment of lung cancer is being increasingly applied worldwide in the last few years. Since its introduction, many publications have been providing strong evidences that this minimally invasive approach is feasible, safe and oncologically efficient; offering to patients several advantages over traditional open thoracotomy, particularly for early-stage disease (I and II). The application of VATS for locally advanced disease treatment has also been largely described, but probably requires a further level of experience, which is more likely to be found in reference centers, with skilled experts. Although a large multi-institutional prospective randomized-controlled trial is the best way to confirm the superiority of one technique over another, such study comparing VATS versus open lobectomy for lung cancer is unlikely to ever come out. And in this scenario, retrospective data remains as the most reliable source of scientific information. Based on a literature review, the main objective of this article is to discuss to what extent VATS lobectomy can be considered the gold standard in the surgical treatment of lung cancer, taking into account the most important comparison aspects between the minimally invasive approach and open thoracotomy technique. This review addresses questions regarding lymph node dissection, oncologic efficacy, extended resections beyond standard lobectomy, post-operative complications/pain/quality of life, survival rates and the present limits of indication (and contraindication) for VATS, in order to define the real role of this technique on the surgical treatment of lung cancer in a minimally invasive, but safe and effective manner.
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Affiliation(s)
- Fernando Vannucci
- Department of Thoracic Surgery, Hospital Federal do Andaraí, Rio de Janeiro, Brazil; Department of Thoracic Surgery, Hospital Central da Polícia Militar (HCPM), Rio de Janeiro, Brazil.
| | - Diego Gonzalez-Rivas
- Department of Thoracic Surgery and Lung Transplant, Coruña University Hospital, Coruña, Spain; Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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