Robotic Bronchoplasty for Iatrogenic Bronchial Rupture After Endotracheal Tube Placement.

The double-lumen endotracheal tube (DLT) was introduced by Carlens in 1949 and became widely used for single-lung ventilation. DLTs have since become standard for most pulmonary resections. Although the use of DLTs is routine and safe in experienced hands, it is not without risk.

Adult Plastic Bronchitis: A Rare Cause for Chronic Productive Cough.

Plastic bronchitis is a rare disease with serious morbidity. We report a case of a 48-year-old male smoker with a past medical history of diabetes, emphysema, recurrent respiratory infections, a worsening productive cough, and increased oxygen requirement over the past 3 months. Often described in the pediatric population, it is important to maintain plastic bronchitis in the differential when considering unresolving pulmonary conditions with chronic sputum production.

Intraoperative Communication Among Men and Women Surgeons With Nursing and Anesthesia Providers.

Introduction: Gender bias has been reported by women surgeons, but its impact on communication in the operating room (OR) is unclear. OR communication is critical to understand, as it directly impacts patient outcomes. The current study evaluates potential gender bias in the type and quality of communication between surgeons and OR nursing and anesthesia providers.

Robotic-Assisted Pleurectomy Is a Safe and Effective Surgical Treatment for Spontaneous Pneumothorax.

Introduction: Spontaneous pneumothorax is a common thoracic surgical problem. To prevent recurrence, surgical options include blebectomy, mechanical or chemical pleurodesis, pleurectomy, or a combination of these operations. Pleurectomy is associated with lower recurrence rates but may be technically challenging via video-assisted thoracoscopic surgery.

The Surgical Renaissance: Advancements in Video-Assisted Thoracoscopic Surgery and Robotic-Assisted Thoracic Surgery and Their Impact on Patient Outcomes.

Minimally invasive thoracic surgery has advanced the treatment of lung cancer since its introduction in the 1990s. Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS) offer the advantage of smaller incisions without compromising patient outcomes. These techniques have been shown to be safe and effective in standard pulmonary resections (lobectomy and sub-lobar resection) and in complex pulmonary resections (sleeve resection and pneumonectomy).

Trends and comparative outcomes between operative approaches for segmentectomy in lung cancer.

Background: Segmentectomy is increasingly performed for non-small cell lung cancer. However, comparative outcomes data among open, robotic-assisted, and video-assisted thoracoscopic approaches are limited.

Methods: A retrospective cohort study of non-small cell lung cancer segmentectomy cases (2013-2021) from the Society of Thoracic Surgeons General Thoracic Surgery Database was performed.

Robotic-Assisted Ivor Lewis Esophagectomy.

Robotic-assisted surgery is a safe and effective approach to minimally invasive Ivor Lewis esophagectomy. Outcomes are optimized when surgeons are familiar with the fundamentals of minimally invasive surgery of the esophagus and after gaining sufficient experience with robotic surgical techniques.

Patients' perceptions of the post-pancreatectomy discharge process.

Background: Complications after pancreatectomies contribute to poor outcomes. Patients are expected to identify signs/symptoms leading to these complications but may be poorly educated on how to identify them. We assessed the impact of an educational tool on patient perceptions of, and satisfaction with the discharge process, and its effect on readmission rates.

Robot-Assisted Left Lower Sleeve Lobectomy for Mucoepidermoid Carcinoma.

Surgical resection with lung preservation is the treatment of choice for low-grade mucoepidermoid carcinoma of the tracheobronchial tree. This report describes a case of minimally invasive robot-assisted sleeve resection for tracheobronchial mucoepidermoid carcinoma and provides detailed instruction, with video demonstration, of the operative technique.

The oncologic efficacy of extended thoracic resections.

Locally invasive lung cancers pose unique challenges for management. Surgical resection of these tumors can pose high morbidity due to the invasion into surrounding structures, including the spine, chest wall, and great vessels. With advances in immunotherapy and chemoradiation, the role for radical resection of these malignancies and associated oncologic outcomes is evolving.

Robotic Mediastinal Surgery.

The robotic platform can be viewed as an advanced thoracoscopic instrument and can be utilized for any pathology amenable to thoracoscopic surgery. This ultimately comes down to surgeon comfort, but many have demonstrated the robotic approach to be useful in benign and malignant mediastinal disease in all compartments with at least equivalent-if not superior-outcomes compared to sternotomy for many metrics. There are various robotic approaches to the same compartments (such as with thymectomy), and no one robotic approach has proven superior to another.

Pembrolizumab Improves Survival After Resection of Intracardiac Metastatic Cervical Carcinoma.

Intracardiac metastasis of cervical squamous cell carcinoma (C-SCC) is rare, with historically poor long-term survival. We report the case of a 55-year-old woman with prior metastatic C-SCC who was found to have a right ventricular mass causing functional pulmonic stenosis and multiple pulmonary emboli 19 months after her initial diagnosis. She underwent surgical resection to prevent further embolization and heart failure.

A scoping review of artificial intelligence applications in thoracic surgery.

Objectives: Machine learning (ML) has great potential, but there are few examples of its implementation improving outcomes. The thoracic surgeon must be aware of pertinent ML literature and how to evaluate this field for the safe translation to patient care. This scoping review provides an introduction to ML applications specific to the thoracic surgeon.

COVID-19 and cardiothoracic surgery: Effects on training and workforce utilization in a global pandemic.

Background: The COVID-19 pandemic has disrupted all aspects of healthcare, including cardiothoracic surgery (CTS). We sought to determine the pandemic's impact on CTS trainees' educational experiences.

Methods: A survey was developed and distributed to members of the Thoracic Surgery Residents Association and other international CTS trainees.

Trimodality Approach for Esophageal Malignancies.

Trimodality therapy, or the use of concurrent chemoradiation followed by surgery, is the cornerstone of contemporary management of esophageal cancer. This article discusses the landmark trials and most current data to understand the concepts, applications, and outcomes from trimodality therapy in locally advanced esophageal cancer.

Robotic-Assisted Complex Pulmonary Resection: Sleeve Lobectomy for Cancer.

The use of robotic assistance for complex pulmonary resections such as segmentectomy and sleeve lobectomy has steadily increased in recent years. These operations are technically challenging as they require fine dissection and suturing, which is often difficult to perform using traditional minimally invasive techniques. Robotic surgery is well-suited for complex pulmonary surgery given its specific advantages related to superior optics and precise tissue manipulation and dissection.

National Survey of Burnout and Distress Among Cardiothoracic Surgery Trainees.

Background: Burnout has been linked to poor job satisfaction and increased medical errors, and is prevalent among health care professionals. We sought to characterize burnout and distress among US cardiothoracic surgery (CTS) trainees.

Methods: A 19-question survey was sent to CTS trainees in collaboration with the Thoracic Surgery Residents Association.

Surgical Adjuncts During Esophagectomy.

Esophagectomy is a major operation whereby intraoperative technique and postoperative care must be optimal. Even in expert hands, the complication rate is as high as 59%. Here the authors discuss the role of surgical adjuncts, including enteral access, nasogastric decompression, pyloric drainage procedures, and anastomotic buttressing as adjuncts to esophagectomy and whether they reduce perioperative complications.

Biliary palliation for unresectable pancreatic adenocarcinoma: surgical bypass or self-expanding metal stent?

Background: Standard of care guidelines endorse self-expanding metal stents (SEMS) rather than open surgical biliary bypass (OSBB) for biliary palliation in the setting of unresectable pancreatic ductal adenocarcinoma (PDAC). This study used competing risk analysis to compare short- and long-term morbidity and overall survival among patients undergoing SEMS or OSBB after unresectable or metastatic disease is identified at the time of exploration.

Methods: Single institution retrospective cohort study (n = 127) evaluating outcomes after OSBB and SEMS for biliary palliation in patients found to have unresectable PDAC at exploration.

An effective multi-modality model for single-session cricothyroidotomy training for trainees.

Background: We piloted a curriculum combining a flipped classroom with two-stage narration, role-play, and partial task trainer simulation to teach this critical skill to trainees.

Methods: This "flipped classroom" module (2012-2018) for open and percutaneous cricothyroidotomy (OC and PC) required participants to watch two 4 min training videos for OC and PC. The simulation session consisted of a 45-min hands-on simulation of OC and PC in which participants rotated between the roles of operator, narrator, and critiquer.

Transversus abdominis plane block reduces pain and narcotic consumption after robot-assisted distal pancreatectomy.

Background: Minimizing pain and disability are key postoperative objectives of robot-assisted distal pancreatectomy (RADP). This study tested effects of bupivacaine transversus abdominis plane (TAP) block on opioid consumption and pain after RADP.

Methods: Retrospective case-control study (June 2012 -Oct 2017) evaluating bilateral intraoperative bupivacaine TAP block as an interrupted time series.

Braden scale for pressure ulcer risk predicts rehabilitation placement after pancreatic resection.

Background: Patients undergoing pancreatic resection frequently require rehabilitation facilities after hospital discharge. We evaluated the predictive role of validated markers of frailty on rehabilitation facility placement to identify patients who may require this service.

Methods: Single-center retrospective cohort study of patients who underwent pancreatic resection from 2010 to 2015.