Robotic lobectomy for non-small cell lung cancer.

Over the last 5 years, there has been a tremendous increase in the interest in and use of robotics in thoracic surgery. The focus of this review is on the use of robotics for pulmonary lobectomy, which is being approached with 3 or 4 arm techniques. Early experiences suggest that the learning curve is approximately 20 cases for most surgeons but could be shortened with previous advanced thoracoscopic skills.

Laparoscopic paraesophageal hernia repair.

Repair of the large paraesophageal hernias-types II, III, and IV is a challenging surgical problem. There are many technical modifications to the numerous aspects of surgical repair. The 2 most critical aspects of repair are: (1) aggressive mobilization of the esophagus to restore and ensure length and (2) the underestimated and understudied technique of hiatal closure.

Fully covered self-expanding metal stents are effective for benign esophagogastric disruptions and strictures.

Purpose: Self-expanding fully covered metal stents (CSs) are ideal for use in benign esophagogastric disease. We reviewed our experience with CS to evaluate outcomes, to determine a role for CS in a standard treatment for benign esophageal conditions, and to compare our results with recently published studies.

Methods: We performed a retrospective chart review from 2005 to 2012.

Outcomes in patients who have failed endoscopic therapy for dysplastic Barrett's metaplasia or early esophageal cancer.

Background: Endoscopic therapy (ablation ± mucosal resection) for esophageal high-grade dysplasia (HGD) or intramucosal carcinoma has demonstrated promising results. Little is known about patients who have persistent or progressive disease despite endotherapy. We compared patients who had successful eradication of their disease with those in whom endotherapy failed to try to identify factors predictive of failure and outcomes after salvage therapy.

Length and pressure of the reconstructed lower esophageal sphincter is determined by both crural closure and Nissen fundoplication.

Background: Laparoscopic Nissen fundoplication is comprised of: a wrap thought responsible for the lower esophageal sphincter function and crural closure performed to prevent herniation. We hypothesized gastroesophageal junction competence effected by Nissen fundoplication results from closure of the crural diaphragm and creation of the fundoplication.

Methods: Patients with uncomplicated reflux undergoing Nissen fundoplication were prospectively enrolled.

Safety and utility of mediastinoscopy in non-small cell lung cancer in a complex mediastinum.

Background: Adequate mediastinal staging is crucial in patients with locally advanced non-small cell lung cancer. Mediastinoscopy is often omitted after induction therapy or prior mediastinoscopy because of concerns for potential morbidity, safety and unknown utility. We sought to determine the safety and utility of restaging mediastinoscopy before surgical resection.

Repair of symptomatic giant paraesophageal hernias in elderly (>70 years) patients results in improved quality of life.

Introduction: Giant paraesophageal hernias (PEH) involve herniation ofstomach and/or other viscera into the mediastinum. These are usually symptomatic and commonly occur in the elderly. The benefits and risks of operating on elderly patients with giant PEH have not been clearly elucidated.

Hemoptysis and thoracic fungal infections.

Hemoptysis and thoracic fungal infections are infrequent but challenging problems, especially when encountered in the emergency setting. The evaluation and management of massive and nonmassive hemoptysis is described with special attention to radiologic, bronchcoscopic, and surgical interventions. The important principles of airway control, stabilization, and definitive management are emphasized.

Comparison of open and minimally invasive thymectomies at a single institution.

Background: Most thymectomies are performed via sternotomy. Minimally invasive thymectomy (MIT) has been described but its potential benefits and drawbacks remain unclear.

Methods: A retrospective chart review comparing thymectomies performed via sternotomy to MIT at a single institution between 2005 and 2009.

Is esophagectomy the paradigm for volume-outcome relationships?

Introduction: Esophagectomy is considered one of the most complicated, difficult to perform, and physiologically altering operations performed by surgeons.

Discussion: Outcome, not only depends upon surgeon and hospital volume but also involves a "supporting cast" of health professionals, such as physical therapy and ICU. The complementary skill set of the surgeon may also influence esophagectomy outcomes.