Use of virtual assisted lung mapping (VAL-MAP), a bronchoscopic multispot dye-marking technique using virtual images, for precise navigation of thoracoscopic sublobar lung resection

ObjectiveWe have developed a novel bronchoscopic multiple marking technique to assist resection of hardly palpable lung tumors. Because 3-dimensional virtual images were used and multiple markings made on the lung surface to provide “geometric” information, we termed this technique “virtual assisted lung mapping” (VAL-MAP). The safety and efficacy of VAL-MAP were evaluated.MethodsVirtual bronchoscopy was used to select 2 to 4 appropriate bronchial branches for marking. Bronchoscopy was conducted with the patient under local anesthesia. A metal-tip catheter was inserted into a selected bronchus and advanced to the pleura. The location of the catheter tip was fluoroscopically confirmed, and 1 mL of indigo carmine was injected. This procedure was repeated to complete all the planned markings. Post–VAL-MAP computed tomography was used to visualize the localization of the multiple markings on 3-dimensional virtual images, which were used as references in the subsequent operation.ResultsOf the 95 marking attempts made for 37 tumors in 30 patients, 88 (92.6%) were identified and contributed to the surgery. No clinically evident complications were associated with the procedure. A total of 15 wedge resections and 18 segmentectomies were thoracoscopically conducted, with a successful resection rate of 100%. Multiple markings of the VAL-MAP were complementary, enabling us to achieve complete resection even when 1 of the markings failed. The markings were visible even on interlobar fissures, at the apex, and on the diaphragm, which conventional percutaneous marking can hardly reach.ConclusionsVAL-MAP was safely conducted with satisfactory outcomes in our early experience. Additional confirmation of its safety and efficacy is necessary

グリシン ワ タイガイ ジュンカンシキ サイカンリュウ モデル ニ オイテ ラット ハイ レイホゾンゴ ノ サイカンリュウ ショウガイ オ ケイゲンスル

京都大学0048新制・課程博士博士(医学)甲第10700号医博第2684号新制||医||853(附属図書館)UT51-2004-G547京都大学大学院医学研究科外科系専攻(主査)教授 米田 正始, 教授 三嶋 理晃, 教授 和田 洋巳学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDA

Post-transplant lymphoproliferative disorder following cytomegalovirus reactivation in a lung recipient.

Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication after lung transplantation, for which several risk factors including pretransplant seronegativity for Epstein-Barr virus are known. However, the impact of cytomegalovirus on PTLD remains to be determined. Here, we describe a case of Epstein-Barr virus-associated polymorphic PTLD that developed shortly after treatment for cytomegalovirus reactivation in a lung transplant recipient who was preoperatively seropositive for both cytomegalovirus and Epstein-Barr virus

Three-dimensional imaging for thoracoscopic resection of complex lung anomalies

Abstract Background Building surgical strategies for complex lung anomalies such as congenital pulmonary venolobar syndrome is difficult because of their rarity and variance. Using three-dimensional computed tomography (3D–CT), we can determine strategies safely. We describe a 27-year-old man with multifocal pulmonary malformations who underwent video-assisted thoracoscopic surgery (VATS) using 3D–CT. Case presentation A 27-year-old man presented with hemoptysis associated with complex pulmonary malformations, including a triple-arched vein connecting the superior and inferior pulmonary veins with partial drainage into the inferior vena cava, a systemic and numerous arterial supply to the right lower lobe from the abdominal aorta, abnormal lobulation, and a tracheal bronchus in the right lung. Preoperative simulation using 3D–CT helped to determine the optimal surgical strategy, allowing for successful and safe completion of semi-emergent middle and lower bilobectomy via minimally invasive VATS. Conclusions Preoperative simulation using 3D–CT helped to determine the optimal surgical strategy, allowing for successful and safe completion of surgery even in a complex case

The effect of polyglycolic acid sheet in preventing postoperative recurrent pneumothorax: a prospective cohort study

Abstract Background Primary spontaneous pneumothorax occasionally relapses, even after bullectomy; therefore, coverage of the bullectomy staple line for pleural reinforcement is common in Japan. However, the appropriate covering materials have not yet been determined. Methods This was a longitudinal prospective cohort study. Data were available for patients aged < 40 years with primary spontaneous pneumothorax who underwent their first thoracoscopic bullectomy between July 2015 and June 2021. We used oxidized regenerated cellulose (ORC) sheets from July 2015 to June 2018, and polyglycolic acid (PGA) sheets from July 2018 to June 2021. The postoperative recurrence-free survival rate was evaluated. The characteristics of the recurrent cases (radiographic, intraoperative, and pathological findings) were also evaluated. The extent of pleural adhesions was classified into the following three groups: none, medium, or extensive. Results A total of 187 patients were included in the study. There were 92 and 95 participants in the ORC and PGA sheet groups, respectively. The postoperative recurrence-free survival rates were significantly higher in the PGA sheet group than in the ORC sheet group (ORC group vs. PGA group, 82.9% vs. 95.4%, p = 0.031). In recurrent cases, there was a significant difference in terms of pleural adhesion (0.0% [12 of 12, none] vs. 100.0% [four of four, extensive], p < 0.001). Conclusions Compared with ORC sheets, PGA sheets are an effective material for preventing early recurrence of primary spontaneous pneumothorax. Strong local pleural adhesions potentially contribute to decreasing recurrence

A meta-analysis of debulking surgery versus surgical biopsy for unresectable thymoma.

Observational studies on long-term outcomes following debulking surgery or surgical biopsy for unresectable thymoma showed various results. This meta-analysis was designed to determine the effect of debulking surgery against surgical biopsy on overall survival in patients with unresectable thymoma. The PubMed database was queried for studies published in the English language on unresectable thymoma and overall survival. We compared overall survival following surgery in patients undergoing debulking surgery and patients undergoing surgical biopsy for unresectable thymoma. Meta-analysis was performed using the Mantel-Haenszel method, and potential publication bias was evaluated with a funnel plot of precision. No randomized trials on this topic were identified. Thirteen retrospective observational studies containing a sum of 314 patients with information on the number of deaths and person-years were suitable for analysis. Information on Masaoka stages, World Health Organization histology and indications for debulking surgery versus surgical biopsy was lacking in most studies. Diversity of neoadjuvant and adjuvant treatments was noted among the eligible studies. One hundred and seventy-two (54.8%) patients underwent debulking surgery and 142 (45.2%) underwent surgical biopsy. The pooled hazard ratio was 0.451 (95% confidence interval: 0.336-0.605, P < 0.001), favouring patients undergoing debulking surgery compared with patients undergoing surgical biopsy. The funnel plot of precision demonstrated no important publication bias. Our results suggest that debulking surgery for unresectable thymoma may be associated with improved overall survival and be considered for patients with unresectable thymoma

Thymic Neuroblastoma within a Thymic Cyst in an Adult

Case Presentation: A 65-year-old female patient with no clinical manifestations was hospitalized for examination and treatment of an anterior mediastinal tumor found at the time of a regular health checkup. Enhanced computed tomography (CT) and magnetic resonance imaging revealed a cystic lesion containing a solid tumor. Positron emission tomography-CT demonstrated increased uptake in the solid lesion. Tumor resection with total thymectomy was performed. A pathological diagnosis of thymic neuroblastoma within a thymic cyst was made. Micorscopic examination revealed that tumor cells of the solid component were lined with thymic epithelial cells of the inner cyst wall. Furthermore, some tumor cells of the solid component had melanin granules. These findings suggest that this tumor arose from progenitors of the thymic epithelial cells with the potential to differentiate along neural lines. Conclusions: Neuroblastoma commonly occurs in children. However, the diagnosis of neuroblastoma in adults has been reported in several case reports. We report an adult case of histogenetically informative thymic neuroblastoma within a thymic cyst. There are no standard treatment strategies and chemotherapy protocols. Complete surgical resection might be important for a better outcome