Limited upper sternotomy in general thoracic surgery.

PURPOSE: To evaluate the status of limited upper sternal split in general thoracic surgery. METHODS: We reviewed the clinical files of 100 consecutive patients operated on through limited upper sternotomy at a hospital in Italy during the 10 years between January 1995 and December 2004. RESULTS: Thymus surgery represented the main indication for this approach (n = 51): for myasthenia without thymoma in 28 patients, for thymus neoplasms with or without myasthenia in 22, and for intrathymic parathyroid adenoma in 1. Thyroid surgery constituted the second main indication for upper sternal split (n = 32) for benign retrosternal goiter in 18 patients, for mediastinal nodal metastasis of thyroid cancer in 11, and for malignant retrosternal goiter in 3. The remaining indications were as follows: to assess residual disease following chemotherapy for Hodgkin's disease in 7 patients and for non-Hodgkin lymphoma in 1; for tracheal surgery in 7; and for excision of nodal mediastinal metastasis of non-thyroid cancer in 2. All operations were completed through the upper sternal split. There was no surgical mortality but complications developed in eight patients. CONCLUSION: The upper sternal split provides a satisfactory access to perform a surgical procedure in the superior mediastinum in most diseases. The procedure is safe and involves minimal surgical trauma.

Initial evaluation of the "Trauma surgery course".

BACKGROUND: The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course), developed as a model for teaching operative trauma techniques, and assess its efficacy. METHOD: the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. RESULTS: All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. CONCLUSION: A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses.