634 research outputs found
Bronchial and arterial sleeve resection for centrally-located lung cancers
The use of bronchial and arterial sleeve resections for the treatment of centrally-located lung cancers, when available, has become the option of choice in comparison with pneumonectomy (PN). Technical expertise, in particular in vascular reconstruction, and perioperative management improved over time allowing excellent short-term and long-term results. This is even truer if considering literature data from the main experiences published in the last years. These evidences have given to such lung sparing reconstructive procedures more and more acceptance among the surgical community. This article focuses on the main technical aspects and literature data regarding bronchovascular sleeve resections
Reconstruction of the pulmonary artery
Sleeve resection and prosthetic reconstruction of the pulmonary artery have progressively gained acceptance as an alternative to pneumonectomy in lung cancer surgery. Previous concern was mainly related to technical difficulties, intraoperative and postoperative complications, lack of long-term survival, and impact on cardiopulmonary function. For this reason it was not until very recently that lobectomy associated with resection and reconstruction of the pulmonary artery, associated or not to a sleeve resection of the bronchus, has been demonstrated to be an advantageous alternative. The concern about an increased complication rate has been proven to be excessive; in fact, pulmonary artery reconstruction can be performed safely and effectively with the correct indications and technique. We hereby report our experience, along with a review of the indications, the surgical technique, and outcome of pulmonary artery reconstruction
The surgical point of view about persistent air leaks: prevention first
No abstract availabl
Vena cava anomalies in thoracic surgery
Background: Vena cava anomalies are a rare group of anatomical variations due to an incorrect development of the
superior or inferior vena cava during fetal life. They generally show no clinical relevance and the diagnosis is done due
to the association with congenital heart diseases in most of cases. However, preoperative identification of these anomalies
is mandatory for surgeons to proper surgical planning. If not recognized, lethal complications may occur, as already reported
in literature.
Case presentation: We report a case series of three different unidentified vena cava anomalies in patients undergoing lung
resection. These unrecognized anomalies led to minor complications in two cases and required an accurate intraoperative
evaluation in another.
A careful retrospective evaluation of preoperative radiological images showed the anomalies.
Conclusions: A careful evaluation of the vena cava anatomy at pre-operative imaging is mandatory for thoracic surgeons to
properly plan the surgery and avoid complications
Tracheal surgery
Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases
A Novel Technique for Laryngotracheal Reconstruction for Idiopathic Subglottic Stenosis
Idiopathic subglottic stenosis is the most challenging condition in the field of upper airway reconstruction. We describe a successful novel technique for enlarging the airway space at the site of the laryngotracheal anastomosis in very high-level reconstructions
Salvage resection of advanced mediastinal tumors
The surgical treatment of locally advanced mediastinal tumors invading the great vessels and
other nearby structures still represent a tricky question, principally due to the technical complexity of the
resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper
management of pathophysiologic issues. Published large-number series providing oncologic outcomes
of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few.
Furthermore, the wide variety of different histologies included in some of these studies, as well as the
heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear
oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring
structures were not offered to patients because of related morbidity and mortality and limited information
available on the prognostic advantage for long term. However, in the last decades, advances in surgical
technique and perioperative management, as well as increased oncologic experience in this field, have allowed
radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding
structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in
association or not with adjuvant chemo- or radiotherapy regimens, achieving encouraging oncologic results
with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending
cardiovascular collapse due to the compression by the large mass are the most frequent immediately lifethreatening
problems that some of these patients can experience. In this setting, medical palliation is usually
ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option
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