Minerva chirurgica
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Minimally invasive techniques have been successfully applied to esophageal surgery. Initially, they were used for benign disease, but as experience has increased, so have the indications for minimally invasive esophageal surgery. Today, minimally invasive esophagectomy has been reported in all types of patients with a variety of esophageal diseases and different stages of esophageal cancer. ⋯ This article provides an update on the myriad of options for performing minimally invasive esophagectomy including advantages and disadvantages of each option and outlines the surgical technique for each. It highlights the current debate on open versus minimally invasive esophagectomy. Since there is no consensus on the operative approach to open esophagectomy, it is not surprising that a number of debates over the best operative approach to minimally invasive esophagectomy exist today.
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Surgical resection of lung metastases has become routine and the introduction of video assisted thoracic surgery (VATS) has provided a mini-invasive option to this treatment. However, oncological radicality of VATS is criticized especially in the event of deeply located lesions requiring manual palpation and lymph node dissection. ⋯ New perspectives are represented by the transxiphoid port, which may allow hand palpation during VATS, and awake lung metastasectomy in epidural anesthesia, which can permit a reduction of global operating room time. In conclusion, VATS metastasectomy is valid in selected but increasing number of patients, without compromising oncologic radicality.