Thoracic surgery clinics
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The authors' initial experience with awake videothoracoscopic lung resection suggests that these procedures can be easily and safely performed under sole thoracic epidural anesthesia with no mortality and negligible morbidity. One major concern was that operating on a ventilating lung would render surgical maneuvers more difficult because of the lung movements and lack of a sufficient operating space. Instead, the open pneumothorax created after trocar insertion produces a satisfactory lung collapse that does not hamper surgical maneuvers. ⋯ Awake thoracic surgery will benefit from evidence-based data that are progressively accumulating. Findings will stimulate experts to continue an active clinical investigation in this unpredictably evolving surgical field, which might ultimately lead to a better understanding of cardiorespiratory physiology and effects of the surgical pneumothorax and thoracic epidural anesthesia on perioperative, respiratory function in awake patients. As the Italian architect Renzo Piano recently stated, "Recovering in the past can be reassuring but the future is the only place where we can go."
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Thoracic surgery clinics · Aug 2008
ReviewVideo-assisted thoracic surgery lobectomy: centers of excellence or excellence of centers?
VATS lobectomy, as defined by CALGB 39802, provides the same oncologic surgery as that performed through a thoracotomy. Standardizing the terminology is the first step that must be undertaken to standardize the operation. VATS lobectomy is the use of technology to aid in performing an established procedure. ⋯ During this transition, the authors would encourage the community of surgeons performing this procedure to submit their statistics to a nationwide database. This will provide an excellent database for evidence-based medicine. Such rigorous data collection should permit thoracic surgeons to be appropriately compensated for performing these technically challenging procedures.
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Thoracic surgery clinics · Aug 2008
Comparative StudyCost comparison of robotic, video-assisted thoracic surgery and thoracotomy approaches to pulmonary lobectomy.
The financial impact of employing minimally invasive techniques for lobectomy compared with traditional open thoracotomy was assessed. A retrospective review was conducted using ICD9 codes for thoracotomy, video-assisted thoracic surgery (VATS), and robotic VATS lobectomy to determine total average costs associated with the resultant hospital stay. ⋯ The average cost of VATS is substantially less than thoracotomy primarily because of a decreased length of stay. The cost of robotic assistance for VATS is still less than thoracotomy, but greater than VATS alone.
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Thoracic surgery clinics · Aug 2008
ReviewThe variability of practice in minimally invasive thoracic surgery for pulmonary resections.
Thoracic surgeons participating in this survey seemed to have clearly indicated their perception of VATS major lung resections, in particular VATS lobectomy. 1. The acronym VATS as a short form of "video-assisted thoracic surgery" was the preferred terminology. 2. According to the respondents, the need or use of rib spreading served as the defining characteristic of "open" thoracic surgery. 3. ⋯ In addition, the survey confirmed that the time-honored muscle-dividing thoracotomy is still widely used. The opportunity for a progressive move toward the routine use of less invasive approaches for major pulmonary resections, however, is already well within sight. Given the results of the ESTS survey supporting a stepwise teaching process leading to VATS lobectomy, hybrid and minimally invasive open lung resections (discussed elsewhere in this issue) collectively defined as MITS may serve as starting point in this process to expand the appropriate use of VATS lobectomy in the modern thoracic surgical practice.