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Introduction: New strategies and methods are needed to ensure that new generations can train and acquire surgical skills in a safe environment. Materials and methods: From January 2020 to October 2020, we performed a single centre, prospective observational cohort study. 19 participants (15 students, 4 residents) enrolled and 16 participants (13 students, 3 residents) successfully completed the curriculum. We performed a quantitative data analysis to evaluate its effectiveness in gaining and improving basic surgical endoscopic skills. Results: The time for single knot tying pre-, mid-, and post-training was reduced significantly, the average time (sec) decreased by 79.5 % (p < 0.001), the total linear distance (cm) by 74.5 % (p < 0.001) and the total angular distance (rad) by 71.7 % (p < 0.001). The average acceleration (mm/s2) increased by 20 % (p = 0.041). Additionally, the average speed increased by 23.5 % (p < 0.001), while motion smoothness (m/s3) increased by 20.4 % (p = 0.02). Conclusion: The obtained performance scores showed a significant increase in participants improving their basic surgical performance skills on the endoscopic simulator. This curriculum can be easily implemented in any surgical specialty as part of the residency training curriculum before first exposure in the operation room. All 16 participants recommended the implementation of such simulator training in their surgical training curriculum.
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BACKGROUND: The criteria for chest drain removal after lung resections remain vague and rely on personal experience instead of evidence. Because pleural fluid resorption is proportional to body weight, a weight-related approach seems reasonable. We examined the feasibility of a weight-adjusted fluid output threshold concerning postoperative respiratory complications and the occurrence of symptomatic pleural effusion after chest drain removal. Our secondary objectives were the hospital length of stay and pain levels before and after chest drain removal. METHODS: This was a single-center randomized controlled trial including 337 patients planned for open or thoracoscopic anatomical lung resections. Patients were randomly assigned postoperatively into 2 groups. The chest drain was removed in the study group according to a fluid output threshold calculated by the 5 mL × body weight (in kg)/24 hours formula. In the control group, our previous traditional fluid threshold of 200 mL/24 hours was applied. RESULTS: No differences were evident regarding the occurrence of pleural effusion and dyspnea at discharge and 30 days postoperatively. In the logistic regression analysis, the surgical modality was a risk factor for other complications, and age was the only variable influencing postoperative dyspnea. Time to chest drain removal was identical in both groups, and time to discharge was shorter after open surgery in the test group. CONCLUSIONS: No increased postoperative complications occurred with this weight-based formula, and a trend toward earlier discharge after open surgery was observed in the test group.
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Thoracic outlet syndrome (TOS) is a rare entity responsible for the vascular and/or nervous symptoms of the upper limbs. Unlike the congenital anatomical anomalies that cause TOS, acquired etiologies are even less common. Here, we report the case of a 41-year-old male with iatrogenic acquired TOS secondary to complex chest wall surgery for chondrosarcoma of the manubrium sterni; he was diagnosed with chondrosarcoma of the manubrium sterni in November, 2021. After staging was completed, primary surgery was performed. The operation was complex, with en-bloc resection of the manubrium sterni; the upper part of the corpus sterni; the first, second, and third bilateral parasternal ribs; and the medial clavicles, whose stumps were fixed on the first ribs. We reconstructed the defect using a double Prolene mesh, and bridged the second and third ribs on each side using two screwed plates. Finally, the wound was covered with pediculated musculocutaneous flaps. A few days after the operation, the patient presented with swelling in the left upper limb. Doppler ultrasound revealed slowing-down of the left subclavian vein flow, which was confirmed via thoracic computed tomography angiography. Systemic anticoagulation was initiated, and the patient began rehabilitation physiotherapy six weeks postoperatively. Symptoms had resolved by the 8-week outpatient follow-up, and anticoagulation therapy was stopped at three months; radiological follow-up demonstrated an improvement in subclavian vein flow without thrombosis. To the best of our knowledge, this is the first description of acquired venous TOS after thoracic surgery. Conservative treatment was found to sufficiently avoid the need for more invasive methods.
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Background: Surgical site infections (SSIs) are the most costly and second most frequent healthcare-associated infections in the Western world. They are responsible for higher postoperative mortality and morbidity rates and longer hospital stays. The aim of this study is to analyze which factors are associated with SSI in a modern general thoracic practice. Methods: Data were collected from our department's quality database. Consecutive patients operated between January 2014 and December 2018 were included in this retrospective study. Results: A total of 2430 procedures were included. SSIs were reported in 37 cases (1.5%). The majority of operations were video-assisted (64.6%). We observed a shift toward video-assisted thoracic surgery in the subgroup of anatomical resections during the study period (2014: 26.7%, 2018: 69.3%). The multivariate regression analysis showed that blood loss >100 ml (p = 0.029, HR 2.70) and open surgery (p = 0.032, HR 2.37) are independent risk factors for SSI. The latter was higher in open surgery than in video-assisted thoracic procedures (p < 0.001). In the subgroup of anatomical resection, we found the same correlation (p = 0.043). SSIs are also associated with significantly longer mean hospital stays (17.7 vs. 7.8 days, p < 0.001). Conclusion: As SSIs represent higher postoperative morbidity and costs, efforts should be made to maintain their rate as low as possible. In terms of prevention of SSIs, video-assisted thoracic surgery should be favored over open surgery whenever possible.
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BACKGROUND: Thoracoscopic sublobar resections (TSLRs) are gaining popularity, but are challenging. However, despite technical difficulties, the reported rate of adverse events, complications, and unplanned procedures is low. To understand this paradox, we have studied our series of TSLRs. METHODS: We reviewed our prospective and intention-to-treat database on videothoracoscopic anatomical resections and extracted all planned thoracoscopic segmentectomies from January 2007 to July 2016. Intraoperative and postoperative data were analyzed. Unplanned procedures were defined as a conversion into thoracotomy or an unplanned additional pulmonary resection. RESULTS: During the study period 284 thoracoscopic anatomical segmentectomies were performed in 280 patients. There were 124 men and 156 women with a mean age of 64 years (range, 18 to 86 years). Indication for segmentectomy was a proven or suspected non-small cell lung carcinoma in 184 patients, suspected metastasis in 51 patients, and benign lesion in 49 patients. In total, 23 patients had an unplanned procedure (8%). There were 10 unplanned thoracotomies (9 conversions and 1 reoperation; 3.1%) mainly for vascular injuries, and 15 unplanned additional resections (5.1%) distributed among oncological reasons (n = 7), per operative technical issues (n = 6) and postoperative adverse events (lingular ischemia, n = 2). Considering only the 235 patients operated on for cancer, the unplanned additional pulmonary resection rate for an oncological reason was 3%. CONCLUSIONS: Although lower than for thoracoscopic lobectomies, the rate of unplanned procedure during TSLRs is of concern. It could most likely be reduced by technical refinements, such as a better preoperative planning.
