Tips and tricks in video-assisted thoracoscopic surgery lobectomy.

In 2012, open procedures represented 63% of the total number of lobectomies performed in our unit; in 2015, video-assisted thoracoscopic surgery (VATS) lobectomy numbers increased up to 66% of the total number of lobectomies performed. When carrying out the procedures, we followed the guidelines presented by the International VATS Lobectomy Consensus Group regarding indications, contraindications, preoperative investigations and conversions. In view of 280 VATS major lung resections from May 2012 to May 2016, we describe some tips and tricks that can be useful in this surgical technique, from general principles to single operative procedures.

Transmanubrial osteomuscular sparing approach: different indications.

The surgery of the cervico-thoracic inlet is a challenge for the thoracic surgeon. Several authors have described different approaches - with different degrees of invasiveness - to this anatomical area. We used the transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for six patients with five different indications: 1) left anterior Pancoast tumor; 2) glomus tumor originating from the inferior trunk (C8-T1 roots) of the right brachial plexus; 3) T1 vertebral tumor; 4) right internal jugular chain, Pirogoff confluence and subclavian artery metastatic lymph nodes from thyroid carcinoma; 5) chondrosarcoma of the first left rib. The results have been satisfactory from a surgical point of view, considering that the approach gave a good exposure of the operative field (especially at the cervical level), without cosmetic problems or functional limitations. In our experience, the transmanubrial osteomuscular sparing approach is a valid technique for the treatment of several kinds of tumors of the cervico-thoracic inlet, giving a good exposure of the operative field. In the case of anterior Pancoast tumors, the upper lobectomy may necessitate a further axillary thoracotomy, when fissural adherences are present.

Modified transmanubrial osteomuscular sparing approach for resection of T1 vertebral tumor.

We report a technical modification of the classic transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for the treatment of a T1 vertebral tumor. The goal of the surgical treatment for spinal tumors of the cervico-thoracic area is to excise the vertebral tumor, reconstruct the spinal column, and place an internal fixation device to achieve immediate stabilization. The procedure was necessary for treating a patient who presented with an invasion of T1 vertebral body by multiple myeloma with initial neurological symptoms of epidural spinal cord compression. This approach requires a multidisciplinary team, essentially composed by the thoracic surgeon, who performs the anatomical dissection of the cervico-thoracic area, and the neurosurgeon, who performs the vertebrectomy and placement of a titanium prosthesis (Harm's cage). The operation was successful; the follow-up 6 months after the surgical procedure is normal.