“Novel thoracoscopic approach to difficult posterior mediastinal tumors.”
Al-Mufarrej, F., M. Margolis, et al. (2010).
Gen Thorac Cardiovasc Surg58(12): 636-639.
Thoracoscopic resection is the preferred treatment of posterior mediastinal tumors. However, thoracotomy may be necessary if the tumors are large or adherent; if they are demonstrate invasion or intraspinal growth; or if they are located in the superoposterior mediastinum or posterior costodiaphragmatic angle. We describe a case of a large, adherent posterior costodiaphragmatic mediastinal mass that would have been otherwise difficult to resect thoracoscopically if it were not for the three-dimensional visualization, greater dexterity, and accurate dissection offered by the Da Vinci robot.
“Minimally invasive lung lobectomy: Indication, patient selection, surgical technique and outcome.”
Augustin, F., T. Schmid, et al. (2010).
European Surgery – Acta Chirurgica Austriaca42(5): 204-208.
BACKGROUND: Accurate patient selection is crucial when initiating a VATS (Video Assisted Thoracoscopic Surgery) lobectomy program. Benign and malignant indications comprise different technical problems: while tumor stage and location determine feasibility in malignant cases, severity of adhesions and size and consistency of hilar lymph nodes are limiting factors in benign diseases. METHODS: Based on a retrospective analysis of prospectively collected data on the initial 81 patients, the institutional experience of a recently introduced VATS-lobectomy program with regard to patient selection, lobe-specific technique, and short- (mid-) term results is presented. RESULTS: Stage I non-small cell lung cancer and small intralobar aspergilloma are ideal indications to start a VATS lobectomy program. Conversion rate, mortality rate, major and minor complication rate, and median hospital stay in the study group was 11%, 3%, 5% and 12%, and 9 days, respectively. After a follow-up of median 8 months, 93% of patients with malignant disease have no local or distant tumor recurrence. CONCLUSIONS: Appropriate preoperative workup and careful patient selection are important to keep conversion rate low and morbidity and mortality rates comparable to open surgery. With increasing experience and confidence a stepwise expansion of benign and malignant indications may be considered. © 2010 Springer-Verlag.
“Robotic surgery in thoracic cancer.”
Bodner, J., T. Schmid, et al. (2010).
Memo – Magazine of European Medical Oncology3(3): 103-105.
PURPOSE: Recently introduced robotic surgical systems were developed to overcome the limitations of conventional minimally invasive surgery. We analyzed the impact of the da Vinci<sup>TM</sup> surgical robot on general (non-cardiac) thoracic oncologic surgery, especially for pulmonary lobectomy in NSCLC patients. MATERIAL AND METHODS: A systematic review of the literature was performed by accessing the MEDLINE database for entries on robotic surgery for thoracic cancer. RESULTS AND DISCUSSION: The da Vinci<sup>TM</sup> robotic system is currently the only commercially available robotic surgical system. There is no role for the robot in pulmonary metastasectomy. Several retrospective analyses and case series prove safety and feasibility of robotic-assisted lobectomy for early-stage NSCLC. Strictly spoken, however, this is a hybrid procedure of robotic and conventional thoracoscopic surgical techniques. For no oncologic long-term follow-up data are available by now, an oncologic valuation of the robotic approach is not appropriate yet. © 2010 Springer.
Ross, R. E., G. S. Schwartz, et al. (2010).
Journal of Robotic Surgery: 1-3.
The advantages of robotic-assisted surgery have been well described and include improved three-dimensional visualization, increased precision of dissection, and the absence of tremor. These characteristics are particularly useful in the mediastinal dissection of major vascular structures. We present a case of an intrapericardial bronchogenic cyst resected with robotic assistance. Bronchogenic cysts are congenital thoracic anomalies that typically occur in the mediastinum or lung parenchyma, and occasionally within the pericardium. Historically a sternotomy was required for complete resection, although a thoracoscopic approach has now been widely adopted. We report the resection of an intrapericardial bronchogenic cyst utilizing a robotic-assisted thoracoscopic approach and a review of the literature regarding the incidence, diagnosis, and management of this rare condition. © 2010 Springer-Verlag London Ltd.