Robotically Assisted Lobectomy: Learning Curve and Complications

The past two decades have witnessed a revolutionary transition in surgical technique and technology with the development of minimally invasive approaches. Many advantages were obtained by using video-assisted thoracoscopic surgery: less surgical trauma and pain, shorter hospital stay, and satisfactory cosmetic results. Limitations still remain, however, because of impaired vision, restricted instrument-maneuverability, unstable camera platform, and poor ergonomics for the surgeon. Some of the more prominent limitations involve the technical and mechanical nature of the equipment. This article describes technical aspects, learning curve, and complications in the field of robotic lobectomy

A high vascular count and overexpression of Vascular Endothelial Growth Factor (VEGF) are associated with unfavorable prognosis in operated Small Cell Carcinoma (SCLC)

It has been widely demonstrated that neo-angiogenesis and its mediators (i.e. vascular endothelial growth factor), represent useful indicators of poor prognosis in non small cell lung carcinoma. In order to verify whether neovascularization and vascular endothelial growth factor may be considered useful markers of clinical outcome also in the small cell lung cancer subgroup, we retrospectively investigated a series of 75 patients with small cell lung carcinoma treated by surgery between 1980 and 1990. Immunohistochemically-detected microvessels and vascular endothelial growth factor expressing cells were significantly associated with poor prognosis, as well as with nodal status and pathological stage. In fact, patients whose tumours had vascular count and vascular endothelial growth factor expression higher than median value of the entire series (59 vessels per 0.74 mm2 and 50% of positive cells, respectively), showed a shorter overall and disease-free survival (P=0.001, P=0.001; P=0.008, P=0.03). Moreover, the presence of hilar and/or mediastinal nodal metastasis and advanced stage significantly affected overall and disease-free interval (P=0.00009, P=0.00001; P=0.0001, P=0.00001). At multivariate analysis, only vascular endothelial growth factor expression retained its influence on overall survival (P=0.001), suggesting that angiogenic phenomenon may have an important role in the clinical behaviour of this lung cancer subgroup