1,720,980 research outputs found
Robotic surgery for lung cancer
No full textDuring the last decade the role of minimally invasive surgery has been increased, especially with the introduction of the robotic system in the surgical field. The most important advantages of robotic system are represented by the wristed instrumentation and the depth perception, which can overcome the limitation of traditional thoracoscopy. However, some data still exist in literature with regard to robotic lobectomy. The majority of papers are focused on its safety and feasibility, but further studies with long follow-ups are necessary in order to assess the oncologic outcomes. We reviewed the literature on robotic lobectomy, with the main aim to better define the role of robotic system in the clinical practice
Pulmonary radiofrequency ablation in a single lung patient
No full textRecurrence in the contralateral lung of patients who have undergone pneumonectomy for lung cancer is often not surgically treatable. Percutaneous radiofrequency ablation (RFA) of tumours is an emerging minimally invasive technique which has recently been used in the treatment of lung cancer. The case history is presented of a patient who had previously undergone pneumonectomy in whom recurrence of lung cancer was treated by RFA. The procedure was performed under CT guidance and was uneventful. At follow up 9 months later the tumour appeared to have ablated. To our knowledge, no similar case has previously been reported in the literatur
Video-assisted thoracoscopic surgery with spontaneous breathing laryngeal mask anesthesia: Preliminary experience.
No full text
Biological effects of radiofrequency thermal ablation on non-small cell lung cancer: results of a pilot study
No full textOBJECTIVES:
Radiofrequency ablation of lung tumors is an emerging technique with promising results. To achieve more information on its effects on pulmonary parenchyma and primary tumors, and to assess its efficacy in determining complete necrosis of the lesion, we led a pilot study consisting of thermal ablation followed by surgical resection.
METHODS:
Ten patients with early stage non-small cell lung cancer were enrolled in the study. In 5 patients radiofrequency ablation was achieved through thoracotomy just before the surgical resection. In another 5 patients radiofrequency ablation was performed percutaneously, under computed tomography guidance, and the surgical resection was performed after 15 days.
RESULTS:
Nine of the 10 patients enrolled in the study were available for analysis. There were 8 men and 1 woman with a mean age of 65.5 years. In all cases histologic diagnosis was available before radiofrequency ablation; adenocarcinoma was identified in 5 patients, and squamous cell carcinoma was identified in 4 patients. Microscopic examination showed complete necrosis of the tumor in 6 of 9 cases. No anatomopathologic alterations were seen in surrounding distant parenchyma.
CONCLUSIONS:
Our study confirms the safety of radiofrequency ablation, particularly underlining the possibility of performing a thermal lesion in the lung in a controlled manner. It also assesses that radiofrequency ablation may be effective in the local control of primary lung cancer. However, surgery still represents the mainstay of treatment of non-small cell lung cancer, and radiofrequency ablation must be reserved for high-risk patients
Minimally invasive mediastinal surgery
Full text linkAbstract
In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a "no-touch" technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally invasive approaches. Furthermore, increased robotic experience and studies, including randomized controlled trials, are needed to validate the findings of the current literature. © Annals of Cardiothoracic Surgery
A case of sequential endoscopic-surgical lung volume reduction: a bridge to lung transplantation
No full textBronchoscopic lung volume reduction (BLVR) and surgical lung volume reduction (SLVR) are two different approaches used to remodel emphysematous lungs to improve lung function. Both these therapies can also be considered as bridge treatment for lung transplantation. We present a case of a man, suffering from severe bullous emphysema, that was evaluated as a candidate for lung transplantation. The presence of pulmonary nodules, in the left upper lobe, would have precluded this possibility. Thus, after a multidisciplinary discussion, we planned a BLVR of the right upper lobe in order to safely perform, few months after, SLVR and wedge resection of the lung nodules via uniportal-video-assisted-thoracic-surgery (U-VATS). To our knowledge, no similar case has previously been reported in the literature
Transcollation technique in the thoracoscopic treatment of primary spontaneous pneumothorax
No full textOBJECTIVES: The already low invasiveness of the thoracoscopic treatment of spontaneous pneumothorax may be further reduced by the transcollation® technique. Herein, we report our further experience with a new device, to coagulate blebs and bullae, compared with contrastto endostapler resection. METHODS: Data of patients with recurrent or persistent spontaneous pneumothorax, who underwent thoracoscopic treatment, were prospectively collected and reviewed. Those with blebs or bullae (Stages III and IV in accordance with Vanderschueren’s classification) were treatedwithanewdevice,basedoncouplingsalinesolutionperfusionwithradiofrequencyenergy.Thecombinationof fluidwithradiofrequencyallowsthesealing of tissue, avoiding charring or burning.Mostoperationswere performed through two1-cmincisions only. RESULTS: From 2005 to 2010, 73 patients were treated. These were 59 males (80.8%) and 14 females (19.2%), with a mean age of 27.9 years[standarddeviation(SD):11.7].Forty-threepatientsunderwentgeneral anaesthesiawithselectiveintubation,9awakeepiduralanaesthesia and 21 spontaneous breathing anaesthesia with laryngeal mask. The mean operation time was 31 min (SD: 10.2). The median postoperative drainage period and hospital stay were 2 days (range of 1–11) and 3 days (range of 2–11), respectively. Prolonged air leak occurredin 1patient (1.4%).Overamean follow-upperiod of 60 months (SD: 22.5), tworecurrences (2.7%)were reported. CONCLUSIONS: The transcollation® technique by cold coagulation of blebs and bullae seems to be effective in the treatment of primary spontaneous pneumothorax. Owing to its potential advantages, it appears to be particularly suitable to be associated with awake epidural and LMA anaesthesia
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