Thoracic surgery clinics
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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.
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Thoracic surgery clinics · Feb 2008
ReviewPreoperative cardiac evaluation of lung resection candidates.
Patients who have lung cancer typically have both pulmonary and cardiac disease as a result of cigarette smoking and are potentially at increased risk for perioperative cardiopulmonary complications. Knowledge of risk factors and a careful preoperative assessment will help the medical team stratify the patient's level of risk and employ measures to minimize surgical risk. The available literature specific to cardiac risk and lung cancer surgery is minimal, but the general principles of preoperative cardiac risk evaluation and perioperative management have been reviewed. When considering cardiac testing and interventions, the medical consultant must remember that surgery is the treatment of choice for non-small cell lung cancer and must avoid any excessive delay that might compromise the patient's chance of a surgical cure.
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Thoracic surgery clinics · Nov 2007
ReviewCorrelative anatomy for thoracic inlet; glottis and subglottis; trachea, carina, and main bronchi; lobes, fissures, and segments; hilum and pulmonary vascular system; bronchial arteries and lymphatics.
Because it is relatively inexpensive and universally available, standard radiographs of the thorax should still be viewed as the primary screening technique to look at the anatomy of intrathoracic structures and to investigate airway or pulmonary disorders. Modern trained thoracic surgeons must be able to correlate surgical anatomy with what is seen on more advanced imaging techniques, however, such as CT or MRI. More importantly, they must be able to recognize the indications, capabilities, limitations, and pitfalls of these imaging methods.