Minerva chirurgica
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Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related mortality worldwide. Despite recent advances in molecular characterization, targeted and adjuvant therapies of NSCLC, surgical resection remains the mainstay of curative treatment. Minimally invasive video-assisted thoracic surgery (VATS) techniques, in particular VATS lobectomy, are being increasingly utilized over traditional thoracotomy approaches in the treatment of localized NSCLC for the reported benefits with respect to postoperative recovery and the conviction of oncologic equivalence. This article will review the major VATS procedures, including their development, outcomes, and purported advantages over thoracotomy, as well as highlight new advances, such as robotic-assisted procedures.
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Idiopathic segmental infarction of the greater omentum is an uncommon condition that should be considered in the differential diagnosis of right-side abdominal pain. The case presented concerns a 40-year old woman admitted with right flank pain. Computed tomography scan of the abdomen showed the characteristic features of greater omentum infarction. ⋯ Segmental infarction of the greater omentum is usually treated conservatively. Nevertheless, surgical intervention may be necessary in order to establish definitive diagnosis and treatment. In this respect, laparoscopic approach offers substantial advantages for the patients while permitting definitive diagnosis and treatment.
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Obesity is commonly thought to be a risk factor for morbidity and mortality after cardiac surgery. The aim of the present study is to evaluate the effects of variations in body mass index on in-hospital outcome of coronary artery bypass grafting (CABG). ⋯ According to this study, obese patients undergoing CABG are not at a greater risk of perioperative death and other adverse outcomes compared to normal weight. After CABG, underweight patients are at higher risk of developing gastrointestinal complications compared to normal patients.
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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.