Evolution of a minimally invasive oesophagectomy program - effective complication management is key.

Introduction: Despite improvements in patient selection, operative technique, and postoperative care, oesophagectomy remains one of the most morbid oncologic resection types. Introduction of minimally invasive practice has been shown to have a greater marginal benefit for oesophagectomy than most of the other types of procedures.

Aim: To evaluate early surgical outcomes through the adoption of totally minimally invasive oesophagectomy and accumulating experience in perioperative management.

Uniportal video-assisted thoracoscopic surgery esophagectomy outcomes in 40 consecutive patients.

Objectives: Minimally invasive esophagectomy has improved over time becoming faster and less invasive. We have changed our technical approach from multiportal to uniportal video-assisted thoracoscopic surgery (VATS) esophagectomy over the years. In this study, we analysed our results with uniportal VATS esophagectomy technique.

Consensus on technical procedures for simulation-based training in thoracic surgery: an international needs assessment.

Objectives: To identify and prioritize technical procedures for simulation-based training to be integrated into the thoracic surgical curriculum.

Methods: A 3-round Delphi survey was conducted from February 2022 to June 2022 among 34 key opinion leaders in thoracic surgery from 14 countries worldwide. The 1st round was a brainstorming phase to identify technical procedures that a newly qualified thoracic surgeon should be able to perform.

Online Survey Evaluation of Three Years of European Society of Thoracic Surgeons Educational Webinars as Part of The E-learning Platform.

Background: E-learning has become an important tool in surgical education in the last decade. The European Society of Thoracic Surgeons launched its e-learning platform in 2013 and started its educational webinars series in 2018. The aim of this paper is to discuss the introduction, evolution and impact of the educational webinars within this e-learning platform.

Macroscopic complete resection is not associated with improved survival in patients with malignant pleural mesothelioma.

Objective: Macroscopic complete resection (MCR) is the recommended surgical strategy in malignant pleural mesothelioma. Our objective was to analyze whether MCR influences survival in malignant pleural mesothelioma.

Methods: Between 2002 and 2016, 154 patients underwent pleurectomy decortication (n = 90), extrapleural pneumonectomy (n = 42), or exploratory/diagnostic procedures (n = 22) in a single institution.

Minimally invasive techniques in thymic surgery: a worldwide perspective.

Minimally invasive surgical techniques are important in surgical management of thymic pathologies. Traditional access techniques are being replaced with minimally invasive techniques using multiportal or uniportal approach. Adoption of minimally invasive techniques for thymic malignancies has been slow due to long term recurrence concerns.

Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program.

Malignant mesothelioma (MM) is an important health problem due to ongoing asbestos exposure. Environmental asbestos exposure leads to a high risk of MM in Turkey. The Turkish Mesothelioma Working Group and the Turkish Public Health Institute designed and performed the Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program (TUNMES-EAECP).

No Adverse Outcomes of Video-Assisted Thoracoscopic Surgery Resection of cT2 Non-Small Cell Lung Cancer during the Learning Curve Period.

Background: Video-assisted thoracoscopic surgery (VATS) anatomic lung resections are gradually becoming the standard surgical approach in early-stage non-small cell lung cancer (NSCLC). The technique is being applied in cases of larger tumors depending on the experience of the surgical team. The objective of this study was to compare early surgical and survival outcomes in patients undergoing anatomic pulmonary resections using VATS and thoracotomy techniques for clinical T2 NSCLC during the adaptation period of the surgical team to the VATS approach.

Extrapleural pneumonectomy (EPP) pleurectomy decortication (P/D).

Surgical techniques for treatment of malignant pleural mesothelioma (MPM) have improved over the decades. The main surgical principle was accepted as macroscopic complete resection. This principle was achieved with extrapleural pneumonectomy (EPP) and extended pleurectomy/decortication (P/D).

Radiation field size and dose determine oncologic outcome in esophageal cancer.

Background: Locoregional recurrence is a major problem in esophageal cancer patients treated with definitive concomitant chemoradiotherapy. Approximately half of the patients fail locoregionally. We analyzed the impact of enlarged radiation field size and higher radiation dose incorporated to chemoradiotherapy on oncologic outcome.

Adoption of pleurectomy and decortication for malignant mesothelioma leads to similar survival as extrapleural pneumonectomy.

Objective: We changed our surgical approach to malignant pleural mesothelioma (MPM) in August 2011 and adopted pleurectomy and decortication (PD) instead of extrapleural pneumonectomy (EPP). In this study, we analyzed our perioperative and survival results during the 2 periods.

Methods: All patients who underwent surgical intervention for MPM during 2003-2014 were included.

Feasibility and Complications in Concomitant Lung Resection With Minimally Invasive Repair of Pectus Excavatum.

Minimally invasive repair of pectus excavatum (MIRPE) is the procedure of choice in experienced centers and can be offered in combination with other thoracic procedures. Between 2001 and 2013, 3 cases involving MIRPE and lung surgery were done in our clinic. While postoperative course of 2 procedures (MIRPE and video-assisted thoracoscopic surgery [VATS] segmentectomy and MIRPE and VATS bullectomy) were uncomplicated, the MIRPE and VATS lung biopsy patient developed major complications arising from prolonged air leak and was ultimately managed with an Eloesser flap.

Preoperative chemoradiation therapy decreases the number of lymph nodes resected during esophagectomy.

Background: This study aimed to analyze the effect of preoperative chemoradiation on the adequacy of lymph node dissection.

Methods: Patients with esophageal cancer treated with esophagectomy by the same surgeon between 2004 and 2011 were reviewed. Specimens were examined by the same pathologist.

Do Nuss bars compromise the blood flow of the internal mammary arteries?

Objectives: Minimally invasive repair of pectus excavatum, the so-called Nuss procedure, has become a popular technique in recent years. The internal mammary arteries (IMAs) lie on the posterolateral surface of the sternum, and the Nuss bar is likely to obstruct the blood flow in these arteries. This obstruction could become important in the later stages of the lives of these young people if they were to require coronary artery bypass grafting.

Postoperative psychiatric disorders in general thoracic surgery: incidence, risk factors and outcomes.

Objective: Postoperative psychiatric disorders (PPDs) may complicate the post-surgical outcome. We analysed the types, incidences, risk factors and outcomes of the PPDs in non-cardiac thoracic surgery patients.

Methods: All patients (n=100) undergoing major non-cardiac thoracic surgery from January 2004 to March 2005 were investigated prospectively.

The size of the esophageal hiatus in gastroesophageal reflux pathophysiology: outcome of intraoperative measurements.

Objective: The aim of the study was to investigate the impact of the size of the esophageal hiatus on lower esophageal sphincter pressure (LESP) and acid reflux.

Methods: Patients with gastroesophageal reflux disease who underwent Nissen fundoplication in 2006-2008 were included. All underwent esophageal manometry and 22 had 24-h pH monitoring.

Trimodality treatment of malignant pleural mesothelioma.

Introduction: Multimodality treatment has achieved significant success in local control and treatment of early-stage malignant pleural mesothelioma patients. However, its favorable effect on survival is questionable.

Methods: We have instituted a trimodality treatment protocol consisting of extrapleural pneumonectomy, adjuvant high-dose (54 Gy) hemithoracic irradiation, and platin-based chemotherapy in a multi-institutional setting.

Safety of a thermal vessel sealer on main pulmonary vessels.

Objective: LigaSure (Valleylab, Tyco Healthcare, Boulder, CO) is a novel instrument with widespread use in various surgical disciplines for vessel sealing. It uses heat energy to denature collagen and elastin and achieve vessel sealing. We investigated the safety of LigaSure in pulmonary arteries (PA) and veins (PV).