Diseño y materialización [I+CT] de arquitecturas efímeras con sistemas modulares agregativos

La Volvo Ocean race (VOR) es una regata de vela alrededor del mundo por etapas. En cada puerto de llegada se instala el "Race Village", una auténtica ciudad temporal nómada formada por diversos pabellones. La presente publicación recoge proyectos para la creación de un nuevo pabellón para la Race Village, creados a partir del uso de los contenedores marítimos como exoesqueleto estructural, y utilizando mecanismos compositivos basados en la agregación modular. Se trata de un material estandarizado y normalizado que es apto para una construcción prefabricada, y que se adapta perfectamente a las exigencias del proyecto: carácter itinerante, necesidad de un rápido montaje y desmontaje, y metáfora del transporte marítimo.Volvo Ocean Rac

Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica

Introduction: the aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). Methods: data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. Results: the incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. Conclusions: the risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection

Grupo español de cirugía torácica asistida por videoimagen: método, auditoría y resultados iniciales de una cohorte nacional prospectiva de pacientes tratados con resecciones anatómicas del pulmón

Introduction: our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). Methods: we conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for '90-day mortality' and 'Grade IIIb-V complications'. Results: the series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). Conclusions: more than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort

Sublobar minimally invasive surgery vs. stereotactic ablative radiotherapy for early stage non-small cell lung cancer

Although lobectomy has been traditionally considered the standard treatment for early stage non-small cell lung cancer (NSCLC), lung-sparing resections usually called “sublobar resections” have exponentially increased in their use in the age of minimally-invasive surgery. Sublobar resection, especially anatomical segmentectomy, has shown comparable oncological outcomes in tumors less than 2 cm in diameter without nodal involvement and distant metastasis. On the other hand, more advanced radiation techniques such as stereotactic ablative radiotherapy, have shown excellent local control rates in stage I NSCLC, with low rates of post-treatment complications, so not only is its role growing in inoperable patients, but also in standard-risk stage I patients. There is a need for multicenter randomized trials addressing specifically this issue. This review aims to collect comparative data about the outcomes of both treatment strategies in early stage NSCLC

Uniportal VATS Left Posterobasal Anatomical Segmentectomy (S9+10)

<p>Anatomical sublobar resections, both segmental and subsegmental, are becoming more and more common. They are used to treat benign lesions and pulmonary metastasis, but they are especially used because they have shown comparable oncologic outcomes in early stage adenocarcinomas with lepidic growth [1,2] and better postoperative profiles by preserving more lung parenchyma when compared to lobar resections. The high frequency of anatomical variations make these procedures more challenging than lobar resections [3], but there are some specific anatomical segmentectomies that present more difficulties, which should be addressed.<br></p><p>This video shows a posterobasal (S9+10) left lower lobe segmentectomy for a lepidic adenocarcinoma of 1.7 cm without nodal involvement. Arterial segmental division can be easily achieved when the pulmonary artery is divided by identifying the central branch of the artery (between the upper segment artery A6 and the anterior segment artery A8). Division of the vein requires careful identification of segmental veins for the upper segment, anterior segment, and posterobasal segments. There is a high frequency of variation in the intersegmental veins, so special attention should be focused to clearly determine which of the veins drains S9+10 in order to preserve venous drainage for the remaining segments and avoid segmental infarction [4].</p><p>What the authors find most difficult in this procedure is division of the bronchus and the intersegmental fissures. The segmental bronchus for S9+10 lies just below the arterial stump for the segments, but dissection and division is difficult due to its central location within the lobe. After dissection of the S9+10 bronchus, the authors prefer to first divide the anterior intersegmental fissure (between S8 and S9+10) with endostaplers. After that, they divide the superior intersegmental fissure between the upper segment (S6) and the anterior segment (S8). For this, they place the anvil of the stapler above the pulmonary artery and the segmental bronchus, and pull the parenchyma between those segments (S6 and S8 initially, S6 and S9+10 in the posterior portion) towards the stapler. After this maneuver, segmental bronchial division with a stapler can be easily performed. Finally, it is only necessary to divide the intersegmental fissures, being careful with the segmental veins for the remaining segments in order to preserve them.</p><p>This procedure can be safely performed through uniportal VATS approach.</p> <p><strong>References</strong></p><ol><li>Altorki NK, Kamel MK, Narula N, et al. Anatomical segmentectomy and wedge resections are associated with comparable outcomes for patients with small cT1N0 non-small cell lung cancer. <em><a href="https://doi.org/10.1016/j.jtho.2016.06.031">J Thorac Oncol. 2016;11(11):1984-1992</a></em>.</li><li>Dziedzic R, Zurek W, Marjanski T, et al. Stage I non-small-cell lung cancer: long-term results of lobectomy versus sublobar resection from the Polish National Lung Cancer Registry. <em><a href="https://doi.org/10.1093/ejcts/ezx092">Eur J Cardiothorac Surg. 2017;52(2):363-369</a></em>.</li><li>Nagashima T, Shimizu K, Ohtaki Y, et al. An analysis of variations in the bronchovascular pattern of the right upper lobe using three-dimensional CT angiography and bronchography. <em><a href="https://doi.org/10.1007/s11748-015-0531-1">Gen Thorac Cardiovasc Surg. 2015;63(6):354-360</a></em>.</li><li>Gossot D, Lutz JA, Grigoroiu M, Brian E, Seguin-Givelet A. Unplanned procedures during thoracoscopic segmentectomies. <em><a href="https://doi.org/10.1016/j.athoracsur.2017.05.081">Ann Thorac Surg. 2017;104(5):1710-1717</a></em>.</li></ol

The everlasting issue of prolonged air leaks after lobectomy for non-small cell lung cancer: A data-driven prevention planning model in the era of minimally invasive approaches

Background and Objectives: Prolonged air leaks (PAL) are the most frequent complication after lobectomy for non\u2013small cell lung cancer, even in case of minimally invasive approaches. We developed a novel score to identify high-risk patients for PAL during minimally invasive lobectomy. Methods: A dedicated database was created. We investigated preoperative candidate features and specific intraoperative variables. Univariate and subsequent logistic regression analysis with bootstrap resampling have been used. Model performance has been assessed by reckoning the area under the receiver operating characteristics curve and the Hosmer-Lemeshow goodness of fit. Results: PAL (>5 days) occurred in 72 (15.69%) patients. Five variables emerged from the model. Each one was assigned a score to provide a cumulative scoring system: forced expiratory volume in 1 second below 86% (P = 0.004, 1.5 points), body mass index <24 (P = 0.002, 1 point), active smoking (P = 0.001, 1.5 points), incomplete fissures (P = 0.004, 1.5 points), and adhesions (P = 0.0001, 1 point). The new score provided a stratification into four risk classes. Conclusions: The risk score incorporates either general or more specific variables, providing a risk stratification that could be readily applied intra- and postoperatively. Henceforth, specific technical and management measures could be properly allocated to curb PAL

Uniportal video-assisted thoracic surgery lobectomy: a consensus report from the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS)

Our goal was to report the results of the first consensus paper among international experts in uniportal video-assisted thoracoscopic surgery (UniVATS) lobectomy obtained through a Delphi process, the objective of which was to define and standardize the main procedural steps, optimize its indications and perioperative management and identify elements to assist in future training.The 40 members of the working group were convened and organized on a voluntary basis by the Uniportal VATS Interest Group (UVIG) of the European Society of Thoracic Surgeons (ESTS). An e-consensus finding exercise using the Delphi method was applied to require 75% agreement for reaching consensus on each question. Repeated iterations of anonymous voting continued for 3 rounds.Overall, 31 international experts from 18 countries completed all 3 rounds of questionnaires. Although a technical quorum was not achieved, most of the responders agreed that the maximum size of a UniVATS incision should be ≤4 cm. Agreement was reached on many points outlining the currently accepted definition of a UniVATS lobectomy, its indications and contraindications, perioperative clinical management and recommendations for training and future research directions.The UVIG Consensus Report stated that UniVATS offers a valid alternative to standard VATS techniques. Only longer follow-up and randomized controlled studies will predict whether UniVATS represents a valid alternative approach to multiport VATS for major lung resections or whether it should be performed only in selected cases and by selected centres. The next step for the ESTS UVIG is the establishment of a UniVATS section inside the ESTS databases