Thoracic Surgery Clinics

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Diaphragmatic paralysis is an elevation of the diaphragm caused by a lesion along the neuromuscular axis and may be either bilateral or unilateral. Most commonly, paralysis is unilateral and iatrogenic in nature. Symptoms of this disease may be life-limiting, and when conservative measures fail, surgical therapy may be of significant benefit to patients. With the advent of robotic minimally invasive techniques, diaphragm plication can be a useful therapy for patients with resolution of symptoms, reduced length of hospitalization, and quickened recovery...

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...

Robotic minimally invasive esophagectomy can be safely performed by adhering to key technical principles. Careful development of the gastric conduit with attention to blood supply and conduit orientation is critical. During thoracic dissection, capnothorax can distort the proximity of key mediastinal structures. In particular, care must be taken to avoid damage to the left mainstem bronchus during subcarinal nodal dissection. Robotic approach allows for an oncologically sound procedure and early mobilization of patients postoperatively, thus optimizing short and long-term outcomes...

Robot-assisted thoracoscopic surgery for the treatment of thoracic outlet syndrome and chest wall lesions are burgeoning topics on thoracic surgery. Following publication of the Society of Vascular Surgeons expert statement in 2016, the diagnosis and management of thoracic outlet syndrome is favorably evolving. Robot-assisted first rib resection is a novel approach to the surgical management of thoracic outlet syndrome that may have advantages compared with traditional open surgical approaches. Robot-assisted chest wall resection is technically feasible for a variety of chest wall conditions and may also have advantages compared with thoracotomy approaches...

Robotic tracheobronchoplasty (TBP) is a new surgical approach to treat tracheobronchomalacia (TBM), and is based on open TBP, which has undergone various technical iterations since the 1950s. The robotic approach to TBM may allow for more patients to undergo TBP, and in retrospective series has demonstrated equivalent outcomes compared to open TBP if not superior in terms of postoperative complications. Long-term data are eagerly awaited, and we describe our approach in this article.

Performing robotic thoracic lung resection is becoming an option for patients with complex thoracic disease. The robotic-assisted approach has similar survival with decreased postoperative pain, morbidity, and hospital length of stay compared with the open approach in pneumonectomy, bronchoplasty, and arterioplasty. Appropriate patient selection based on medical and surgical history combined with surgeon experience is imperative for an excellent outcome. This article will discuss the use of the robot in pneumonectomy, arterioplasty, and bronchoplasty to provide information about the technical approach and postoperative management...

Pulmonary segmentectomy is a parenchymal-sparing alternative approach to lobectomy for the surgical management of stage I NSCLC. Segmentectomy is an anatomical resection that requires meticulous dissection and exposure of the segmental pulmonary artery, vein, and bronchus. The open thoracotomy approach has been gradually replaced by video-assisted thoracoscopy (VATS) and robotic-assisted minimally invasive approaches for performing segmentectomy for surgical resection for early-stage lung cancer. There are 2 recent randomized studies that demonstrated that pulmonary segmentectomy is equivalent to lobectomy for the surgical management of NSCLC tumors 2 cm or smaller...

Robotic lobectomy volume in the United States has increased dramatically in the past 10 years. Improved perioperative outcomes and increased public demand for minimally invasive techniques continue to drive its popularity. Preoperative workup is similar to VATs lobectomy and includes appropriate tumor staging, pulmonary function tests, and imaging. Severe intraoperative complications are rare but can be catastrophic; individualized response to each is required.

The use of a robotic surgical platform has become common place in thoracic surgery programs throughout the United States. Formal training paradigms need to be reevaluated to allow for effective and efficient training of thoracic surgery residents and fellows. The utilization of video-based coaching and simulation are effective adjuncts in robotics training.

The rapid adoption of robotic-assisted thoracic surgery has led to increased interest in the management of complications. Overall rates of complication during robotic-assisted thoracic surgery are low. Reported complications include pulmonary vascular injury; great vessel injury; thoracic duct injury; erroneous transection; tracheobronchial injury; and esophageal, diaphragmatic, and abdominal organ injury. A robotic thoracic surgeon should understand and have a management plan for any potential complication...

Robotic-assisted surgery has been widely adopted in the field of thoracic surgery as a safe, minimally invasive approach with distinct technical advantages. With increased utilization, it has become an integral part of training pathways for the next generation of thoracic surgeons. This review article highlights key steps in implementing a robotic thoracic surgery program at an academic center based on institutional experience and the available surgical literature.

Pulmonary nodules (lesions <3 cm in size) are commonly identified on computed tomographic scans, but radiographic features alone are inadequate to reliably differentiate between benign and malignant etiologies. Therefore, tissue biopsy remains the standard approach to determine the appropriate treatment course for many patients with pulmonary nodules. Although percutaneous biopsy is highly accurate, it poses substantial risks of procedural complications, including pneumothorax and bleeding. Robotic bronchoscopy has recently been developed to overcome many of the limitations of previous navigational platforms...

The embracing of new technology and surgical innovation has been one of the hallmarks of cardiothoracic surgery. The adoption of video-assisted thoracoscopic surgery was the paradigm-changing perspective shift that has enabled an entire culture of minimally invasive cardiothoracic surgery. From this foundation robotically assisted thoracic surgery has developed into mainstream practice. The aim of this review is to recount the technological and academic milestones of the past as well as describe future technological innovations that will shape the future of thoracic robotic surgery...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

The optimal management of Siewert Type II or Junction AEG II adenocarcinoma remains a point of debate. Surgical options include an extended total gastrectomy or esophagectomy. Accurately identifying the location of the esophagogastric junction (GEJ) is important as the epicenter of the lesion is defined in reference to the GEJ. Type II tumors, in the most recent iteration of the AJCC, describe these lesions as being within 1 cm cephalad and 2 cm caudal to GEJ. Accurate staging of the location and identification of nodal metastasis is vital to guide the optimal surgical approach...

Reducing perioperative morbidity and mortality following esophagectomy remains central to surgeons' intraoperative decision-making. There remains wide variation in the technical approaches to esophagectomy and the employment of prophylactic strategies to reduce postoperative complications. In this article, we discuss the ongoing controversies related to feeding tube placement, pyloroplasty, and thoracic duct clipping and the evidence regarding these procedures.

Complex esophageal reconstruction represents a high risk and challenging procedure. A dedicated pathway with multispecialty teams can facilitate a systematic checklist approach to perioperative management and evaluation of long-term outcomes. Refinements in the operative technique for supercharged pedicled jejunum (SPJ) for long segment interposition in esophageal reconstruction are reviewed in this article. Medical and surgical complications among this complex niche group of patients are significant and require care in specialist centers with a focused team...