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Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

The increased use of chest computed tomography (CT) has led to an increased detection of pulmonary nodules requiring diagnostic evaluation and/or ...

University of North Carolina at Chapel Hill

To address the lung donor shortage, we obtained institutional review board and US Food and Drug Administration approval to transplant lungs recovered from uncontrolled donation after circulatory determination of death donors (uDCDDs).

Assessment of Lungs for Transplant Recovered from Uncontrolled Donation after Circulatory Determination of Death Donors.

We describe the case of a 35-year-old man who presented in respiratory failure after influenza B infection requiring initiation of venovenous extracorporeal membrane oxygenation and eventual pulmonary resection for necrotizing pneumonia. Following a successful wean off venovenous extracorporeal membrane oxygenation, and once hemodynamically stable, he was taken to the operating room for decortication and left pulmonary resection. Recovery was complicated by persistent airleak requiring placement of endobronchial valves, but otherwise he recovered very well. This case demonstrates the benefits of lung resection for necrotizing pneumonia.

Venovenous Extracorporeal Membrane Oxygenation and Pulmonary Resection for Necrotizing Pneumonia.

Increased use of chest computed tomography and the institution of lung cancer screening have increased the detection of ground-glass and small pulmonary nodules. Intraoperative localization of these lesions via a minimally invasive thoracoscopic approach can be challenging. We present the feasibility of perioperative transthoracic percutaneous nodule localization using a novel electromagnetic navigation platform.

Electromagnetic Transthoracic Nodule Localization for Minimally Invasive Pulmonary Resection.

Airway surgery poses a host of unique challenges to both the surgical and anesthesiology teams. Accordingly, there are a variety of surgical, anesthetic, and airway management options to be strategically considered. Management can be challenging during multidisciplinary preoperative planning, during the surgical procedure itself, and during recovery. In this review, emphasis is placed on anesthesia challenges for patients undergoing major tracheal or carinal surgery with specific considerations related to perioperative management.

Anesthesia for Resection and Reconstruction of the Trachea and Carina.

Enhanced recovery after surgery (ERAS) is an evidence-based, multidisciplinary perioperative care model shown to reduce complications and hospital length of stay (LOS). While some thoracic ERAS studies were inconclusive, others demonstrated that ERAS improves patient outcomes after lung resections and provides more cost-effective care. We aimed to investigate the effects of preliminary implementation of an ERAS protocol, in comparison with conventional care, on lung resection outcomes at a single academic institution.

Thoracic Enhanced Recovery After Surgery: Single Academic Center Observations After Implementation.

In 2008, integrated thoracic residency programs (IP) for cardiothoracic (CT) training were created in response to a decline in CT trainees. However, few studies have reported on trends in the CT training pathway since the inception of IPs. This manuscript examines the current trends related to the overall number of surgical trainees entering CT surgery training following the introduction of IPs into the National Resident Match Program (NRMP).

Recent Trends in Cardiothoracic Surgery Training: Data from the National Resident Matching Program.

Few studies examine outcomes by surgical approach in non-small-cell lung cancer (NSCLC) with N2 disease. We examined time trends in surgical approach and outcomes among patients undergoing minimally invasive (MIS, robotic and video-assisted thoracoscopic surgery [VATS]) vs open lobectomy in this patient population. We performed a retrospective analysis of patients from the National Cancer Database diagnosed with clinical Stage IIIA-N2 NSCLC from 2010 to 2016. We examined the yearly proportion of MIS vs open resections. Multivariable regression was used to assess the association of surgical approach with length of stay, unplanned readmissions, 30-day and 90-day mortality. Multivariable Cox proportional hazards modeling was used to assess the association of surgical approach with 5-year overall mortality. We identified 5741 patients who underwent lobectomy for Stage IIIA-N2 NSCLC (459 robotic, 1403 VATS, 3879 open). From 2010 to 2016, the proportion of minimally invasive procedures increased from 20% to 45%. MIS patients, on average, stayed 1 day less in the hospital (95% confidence interval [CI] 0.7, 1.5) and had lower odds of 90-day (odds ratio [OR] 0.74; 95% CI 0.54, 0.99) and 5-year mortality (OR 0.82; 95% CI 0.75, 0.91), compared to open resections. There was no difference in odds of readmission by surgical approach (OR 0.97; 95% CI 0.71, 1.33). Among MIS procedures, robotic resections had lower odds of 90-day mortality (OR 0.42; 95% CI 0.18, 0.97) than VATS. Among patients undergoing lobectomy for locally advanced N2 NSCLC robotic and VATS techniques appear safe and effective compared to open surgery and may offer short- and long-term advantages.

Trends and Outcomes in Minimally Invasive Surgery for Locally Advanced Non-Small-Cell Lung Cancer With N2 Disease.

Flail chest and severely displaced rib fractures due to blunt trauma can be associated with intrathoracic injuries. At our institution, two thoracic surgeons perform all surgical stabilization of rib fractures (SSRF): one performs routine uniportal thoracoscopy (R-VATS) at the time of SSRF and the other for only select cases (S-VATS). In this pilot study, we hypothesized that R-VATS at the time of SSRF identifies and addresses intrathoracic injuries not seen on imaging and may impact patient outcomes.

Does routine uniportal thoracoscopy during rib fixation identify more injuries and impact outcomes?

A 37-year-old incarcerated male ingested a complex "X-shaped" foreign body that resulted in a penetrating aorto-esophageal injury. A primary esophagotomy with retrieval of the foreign body and muscle flap closure was performed simultaneously with thoracic endovascular aortic repair. This multidisciplinary surgical approach controls for both immediate exsanguination and postoperative complications to improve patient outcome.

Multidisciplinary Management of an Aorto-esophageal Injury Caused by Foreign Body Ingestion.

Cutting Corners in the Mediastinum: Should Contralateral Hilar N3 Nodes Be Omitted From Staging?

Integrated thoracic surgery residency program (IP) applicants often complete away rotations to stand out from the objective standard criteria. Little is known about the perceptions of these rotations. We aimed to examine the perceptions of value, cost, and expectations of away rotations among IP applicants and program directors.

Away Rotations at Integrated Thoracic Surgery Programs: Applicant and Program Director Perspectives.

The impact of cardiovascular and neurologic complications on infective endocarditis (IE) are well studied, yet the prevalence and significance of pulmonary complications in IE is not defined. To better characterize the multifaceted nature of IE management, we aimed to describe the occurrence and significance of pulmonary complications in IE, including among persons with IE related to drug use.

Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample.

Article	Year
Assessment of Lungs for Transplant Recovered from Uncontrolled Donation after Circulatory Determination of Death Donors. Annals of the American Thoracic Society\| PubMed ID: 28945476	2017
Venovenous Extracorporeal Membrane Oxygenation and Pulmonary Resection for Necrotizing Pneumonia. The Annals of thoracic surgery\| PubMed ID: 30086282	2019
Electromagnetic Transthoracic Nodule Localization for Minimally Invasive Pulmonary Resection. The Annals of thoracic surgery\| PubMed ID: 31233723	2019
Anesthesia for Resection and Reconstruction of the Trachea and Carina. Journal of cardiothoracic and vascular anesthesia\| PubMed ID: 31761653	2020
Thoracic Enhanced Recovery After Surgery: Single Academic Center Observations After Implementation. The Annals of thoracic surgery\| PubMed ID: 32805268	2021
Recent Trends in Cardiothoracic Surgery Training: Data from the National Resident Matching Program. Journal of surgical education\| PubMed ID: 32928698	2021
Trends and Outcomes in Minimally Invasive Surgery for Locally Advanced Non-Small-Cell Lung Cancer With N2 Disease. Seminars in thoracic and cardiovascular surgery\| PubMed ID: 32979480	2021
Does routine uniportal thoracoscopy during rib fixation identify more injuries and impact outcomes? Journal of thoracic disease\| PubMed ID: 33209362	2020
Multidisciplinary Management of an Aorto-esophageal Injury Caused by Foreign Body Ingestion. Annals of vascular surgery\| PubMed ID: 33333195	2021
Cutting Corners in the Mediastinum: Should Contralateral Hilar N3 Nodes Be Omitted From Staging? Chest\| PubMed ID: 34021992	2021
Away Rotations at Integrated Thoracic Surgery Programs: Applicant and Program Director Perspectives. Journal of surgical education\| PubMed ID: 34127425	2021
Pulmonary complications observed in patients with infective endocarditis with and without injection drug use: An analysis of the National Inpatient Sample. PloS one\| PubMed ID: 34478475	2021

Jason Long

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