Robotic left intrapericardial upper lobectomy, pericardial reconstruction and diaphragmatic plication.

Primary mediastinal malignant germ cell tumours are rare, comprising only 1-4% of mediastinal tumours, of which 50-70% are non-seminomatous germ cell tumours. Non-seminomatous germ cell tumours typically demonstrate an excellent response to cisplatin-based chemotherapy. However, in some cases, tumours may persistently enlarge despite normal tumour markers following chemotherapy, leading to a rare condition known as growing teratoma syndrome.

Robotic intrapericardial bilobectomy with stapler on the atrium and pericardial reconstruction.

Few intrapericardial robotic lung resection cases have been reported in the literature because of the perceived complexity of the procedure, with most surgeons embarking on an open resection via a thoracotomy. We present the case of a right middle and lower lobe tumour involving the pericardium and the origin of the right middle lobe vein. An intrapericardial lower bilobectomy was performed, with pericardial resection, pre-pericardial fat resection and mesh reconstruction.

Developing and validating machine learning-based prediction models for frailty occurrence in those with chronic obstructive pulmonary disease.

Background: Frailty is a medical syndrome caused by multiple factors, characterized by decreased strength, endurance, and diminished physiological function, resulting in increased susceptibility to dependence and/or death. Patients with chronic obstructive pulmonary disease (COPD) tend to be more vulnerable to frailty due to their physical and psychological burdens. Therefore, the aim of this study was to develop a reliable and accurate vulnerability risk prediction model for frailty in patients with COPD in order to improve the identification and prediction of patient frailty.

Right robotic S4 segmentectomy.

Among the various segmentectomy procedures performed for lung diseases, the right S4 segmentectomy stands out as an exceptionally rare operation. Its infrequent occurrence can be attributed to several factors, including the relatively lower incidence of pathologies necessitating isolated resection of the S4 segment of the right lung. This video tutorial showcases the robotic approach to the rare right S4 segmentectomy, guiding surgeons through the step-by-step procedures for better understanding and proficiency.

Robotic resection of anterior mediastinal masses >10 cm: a case series.

Background: Robot-assisted thoracic surgery (RATS) for intrathoracic pathology and especially for mediastinal mass resection has been increasingly accepted as an alternative method to open sternotomy and video-assisted thoracic surgery (VATS). However, the utilization of this approach for complex and advanced in size cases needs more clinical evidence. We are presenting a series of 4 patients who had resection of >10 cm mediastinal masses via RATS.

Trans-fissure and trans-lobar coil insertion technique for small lesions positioned inside the fissure.

The objective of this study is to present a technique of localization of difficult-to-locate lesions inside the fissure by deploying a coil with one of its ends left inside the fissure, and also, to evaluate the safety and the efficiency of this localization technique. Ten (10) patients with lesions in the fissure were identified during discussion at the multidisciplinary team meeting (MDT) and were recruited in the study. Attending surgeons verified that the lesions were unable to be located with minimally invasive approaches.

Robotic reconstruction of a left hemi-diaphragm defect with double mesh in a patient with trisomy 21.

Robotic reconstructions of large diaphragmatic defects with mesh reconstructions are rare in the literature. We present a case of a complicated diaphragmatic defect, in an adult with trisomy 21, which was successfully repaired robotically with double mesh reinforcement. The meshes were sutured together via a separate suture in the middle to avoid fluid accumulation between them.

Impact of the type of initial intervention on the outcomes of lung volume reduction for emphysema: a propensity matched study.

Background: The type of initial intervention i.e., endobronchial valve (EBV) implantation or lung volume reduction surgery (LVRS) to be offered as initial intervention remains vague in the treatment of emphysema-chronic obstructive pulmonary disease (COPD) patients.

Tracheal laceration causing important post-intubation delayed subcutaneous emphysema and ventilatory deterioration in a COVID-19 patient with severe rheumatoid arthritis: a case report.

A 68-year-old man with a background of severe active rheumatoid arthritis (RA) was admitted to Intensive Care Unit (ICU) for respiratory support due to COVID-19 infection. Two days after an elective and uneventful intubation he developed severe and worsening surgical emphysema affecting his face, neck and both upper limbs. Ventilation was difficult to be achieved.

Continuous endobronchial suctioning for refractory post lobectomy lung atelectasis: a case report.

The presentation of post lung resection atelectasis can vary between simple atelectasis and total lung collapse i.e., "white - out", making its treatment demanding in many occasions.

Preoperative training education with incentive spirometry may reduce postoperative pulmonary complications.

Objective: To assess whether preoperative incentive spirometer training would influence the development of postoperative pulmonary complications after lung resection.

Methods: Sixty-two lung resection patients were prospectively investigated; 17 were given an incentive spirometer preoperatively and 45 did not have an incentive spirometer preoperatively. Postoperatively, both arms exercised with an incentive spirometer.

Procalcitonin Measurement in Pleural Fluid to Predict Infectious Complications of the Chest Post Lung Resection.

Aim: Procalcitonin (PCT) is variably used in clinical practice to identify infectious processes. This study investigated whether PCT level in pleural fluids could predict the infectious complications in the chests of patients undergoing lobectomy.

Patients And Methods: Thirty-four patients undergoing lobectomy for lung cancer were enrolled.

Causing Empyema and Sepsis, Necessitating Early Surgical Decortication.

is an oropharyngeal commensal Gram-positive coccus, frequently associated with the respiratory tract. is part of the or group, which has traditionally been considered to have propensity to cause empyema and purulent abscesses, a property that is sometimes overlooked as the severity of infections it causes may have a varying degree. In this case, we present the case of a 54-year-old male with known liver cirrhosis who developed a severe empyema during an acute liver failure episode, requiring extensive decortication and prolonged hospital admission.

The Impact of a Newly Established Multidisciplinary Team on the Interventional Treatment of Patients With Emphysema.

Background: The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting.

Objectives: To investigate the impact of a newly established dedicated emphysema MDT meeting on the interventional treatment of such patients.

Pleural Pressure Differences Before Removal Are Greater in Patients Who Develop Residual Pneumothorax Post Chest Drain Removal.

We aimed to investigate whether the difference in pleural pressures (Δ) is wider among patients who develop a residual pneumothorax after chest tube removal following lung resection surgery. Ninety-eight patients who underwent lung resection were included in the study over a period of 12 months. The Δ prior to chest tube removal in patients who developed a residual pneumothorax after chest tube removal was compared with that of patients who did not develop this complication.

Ipsilateral pulmonary infarction after major lung resection.

Background Lung infarction is a rare complication of lung resection, developing mainly because of technical errors. In some cases, a specific reason cannot be identified. This study aimed to investigate the occurrence, characteristics, and outcome of this pathology in a series of patients.

Use of Bioglue™ to seal a difficult to treat air leak in a complicated empyema patient.

Surgical sealants have been used in thoracic surgery in an effort to reduce air leak duration, intercostal drain duration, length of stay and complications. They are instilled over a defect usually treated with other means. We herein present the technique of controlling a difficult to treat defect by directly instilling Bioglue™ alone into a crater, caused during empyema Video-assisted thoracic surgery in a 50-year-old patient with a trapped lung.

Do pleural adhesions influence the outcome of patients undergoing major lung resection?

Objectives: Our goal was to investigate whether pleural adhesions identified during an operation can induce adverse events. We investigated the outcome of major lung resection in patients with pleural adhesions encountered on entry into the pleural cavity.

Methods: We conducted a retrospective analysis of 144 patients undergoing major lung resection over a period of 9 months.

Performance of wider parenchymal lung resection than preoperatively planned in patients with low preoperative lung function performance undergoing video-assisted thoracic surgery major lung resection.

Objectives: Pulmonary assessment before major lung resections is used to determine patient's operability. In marginal cases, extensive pulmonary assessment is additionally important under the fear of a more radical parenchymal removal. This study investigates the outcome of wider lung parenchymal resections in patients with low lung functional status undergoing video-assisted thoracic surgery (VATS) major lung resection.

Usefulness of colchicine to reduce perioperative myocardial damage in patients who underwent on-pump coronary artery bypass grafting.

The objective of the present study was to test whether a perioperative course of colchicine, in patients who underwent standard coronary artery bypass grafting, would result in reduced postoperative increase of myocardial injury biomarker levels. Patients were prospectively randomized to colchicine or placebo starting 48 hours before scheduled coronary artery bypass grafting and for 8 days thereafter (0.5 mg twice daily).

Pneumomediastinum.

Pneumomediastinum is a condition in which air is present in the mediastinum. This condition can result from physical trauma or other situations that lead to air escaping from the lungs, airways or bowel into the chest cavity. Pneumomediastinum is a rare situation and occurs when air leaks into the mediastinum.

Delayed presentation of aortoesophageal fistula after endovascular repair.

The incidence of aortoesophageal fistula after thoracic endovascular aortic repair has increased following an increase in thoracic endovascular aortic procedures. A 68-year-old man was diagnosed with aortoesophageal fistula 6 years after thoracic endovascular aortic repair of a descending aortic aneurysm. Due to massive hematemesis and instability, he underwent a left thoracotomy, graft repair of the aorta with stent removal, gastrostomy, and proximal esophagostomy.