A new thoracoscopic technique for pulmonary lobectomies.

Video-assisted thoracoscopic surgery (VATS) for pulmonary lobectomies has recently been introduced as a minimally invasive technique for selected patients. Herein I describe an original technique, which allows for lobectomies under the direct vision of a surgeon respecting the principles that are the basis of the thoracoscopic techniques. The originality of the technique consists in the supine position of the patient and the use of a modified retractor for lower lobectomies. This approach required two ports, an access incision (6-7 cm), and an additional port which may be used for lower lobectomies. Utilizing this technique I operated on twenty patients affected by stage I lung cancer with poor respiratory function. The ability to perform lobectomies with this method allows for shorter operative time than when utilizing previous techniques (80 min. mean operative time) including the lymph nodal dissection. Moreover, cosmetic results were good and patients benefited from excellent early pulmonary function and fast recovery time. I recommend the use of this approach which is a safe technique for the patient and an advantageous procedure for both surgeon and anaesthesiologist.

Thymoma-associated myasthenia gravis: outcome, clinical and pathological correlations in 197 patients on a 20-year experience.

We studied 197 patients with thymoma-associated myasthenia gravis (T-MG) to identify variables that can influence the natural history of the disease and the therapeutical approaches. Multivariate analysis showed that neither clinical nor pathological variables were associated with a better chance to reach complete stable remission. The video-assisted thoracoscopic extended thymectomy (VATET) was not significantly correlated with a lower chance of achieving complete stable remission compared with the classical transsternal approach (T-3b) (p=0.1090). Thymoma recurrence was not correlated with surgery by VATET or T-3b. VATET was safe and reliable for removal of thymoma. The low chance of achieving remission (9.64%) in T-MG underlines the importance of an early diagnosis as well as the need for more aggressive therapeutic strategies.

Superior vena cava replacement in thymic tumours treated with radio-chemotherapy.

From 1987 to 2000 108 patients were operated on for thymic tumours. Two of these underwent replacement of the superior vena cava with polytetrafluoroethylene prostheses because the tumours invaded the superior vena cava. One of these was affected by myasthenia gravis, and was treated preoperatively with concurrent radio-chemotherapy and lymphocytopheresis. The other received preoperative chemotherapy and post-operative radio-chemotherapy because of minimal residual disease. The clinical courses of the two patients are reported here and we conclude that eradication of thymic malignancies is suitable even when superior vena cava replacement is required, and that neither antimyasthenic therapy nor adjuvant and/or neoadjuvant treatment interfere with aggressive surgical management or vice versa. Moreover, the long-term survival of one of these patients despite relapse of disease shows that extended surgery is indicated in these cases.

Tuberous sclerosis with pulmonary involvement. A rare cause of bilateral pneumothorax. A case report.

The authors report a case of bilateral pneumothorax observed in a 25-year-old woman affected by tuberous sclerosis with pulmonary involvement. The singular epidemiological, histopathological, physiopathological, diagnostic and therapeutic aspects of the rare pulmonary localisation of this heredofamilial disease are discussed. Finally, they suggest performing a pleurodesis with a videothoracoscopic method. Such a procedure makes it possible to prevent dangerous pneumothorax recurrences and, in cases where the diagnosis is doubtful, to perform targeted pulmonary biopsies.