Thoracoscopic treatment of mediastinal ectopic parathyroid adenomas: a Latinamerica experience case series and literature review.

BACKGROUND: Hyperparathyroidism (HPT) is a disease caused by hypersecretion of one or more parathyroid glands, it can be associated with ectopic mediastinal parathyroid glands (MEPA) in 2% of cases. The use of video-assisted thoracoscopic surgery (VATS) for the surgical resection of these glands is a safe, cost-effective, and low morbidity option for patients with MEPA. We report a case series of patients with this disease managed with VATS, the first in Mexico and Latinamerica. METHODS: From 2008 to 2022, a retrospective study involving patients with MEPA and treated by VATS approach was performed in a tertiary hospital in Mexico city. Relevant biochemical and clinical variables such as imaging studies, pre and postoperative laboratory results, surgical strategy, outcomes and pathological analysis were analyzed. RESULTS: Four cases of mediastinal parathyroid adenomas causing HPT were included. All patients were female with a median age of 52.5 years-old (range 46-59 years), half of the patients had primary HPT and the others tertiary HPT after kidney transplant. 75% of cases had a MEPA in the medium mediastinum, all had a preoperative positive SPECT-CT 99mTc Sestamibi scan. Mean preoperative PTH was 621.3pg/mL (182-1382pg/mL). All patients successfully underwent parathyroidectomy with a VATS approach, no deaths were reported. CONCLUSIONS: VATS is a minimally invasive surgery that provides adequate access to mediastinal located glands, optimal visualization of mediastinal structures and has a high resection success rate with less complications and morbidity than open approaches.

Erector spinae plane block, neuropathic pain and quality of life after video-assisted thoracoscopy surgery. Pilot, observational study.

BACKGROUND: The erector spinae plane block (ESPB) is a valuable alternative for pain management after video-assisted thoracoscopy surgery (VATS). The incidence of postoperative chronic neuropathic pain (CNP) is high while the quality of life (QoL) after VATS remains unknown. We hypothesised that patients with ESPB would have a low incidence of acute and CNP and would report a good QoL up to three months after VATS. METHODS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. RESULTS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively. CONCLUSIONS: We conducted a single-centre prospective pilot cohort study from January to April 2020. ESPB after VATS was the standard practice. The primary outcome was the incidence of CNP three months postoperatively. Secondary outcomes included QoL assessed by the EuroQoL questionnaire three months after surgery and pain control at the Post-Anaesthesia Care Unit (PACU), 12 and 24 hours postoperatively.

The importance of endobag use with incision-protective devices in VATS lung resection: a preliminary study.

OBJECTIVE: The advent of new techniques such as video-assisted thoracoscopic surgery (VATS) for the removal of lung segments leads to compression of the surgical specimen, with the possible dissemination of neoplastic cells. The sheer volume of surgeries performed using these techniques has caused many institutions to stop removing the surgical specimen using an endobag, even when retractors/protectors are used in the instrumentalization incision. This study aimed to collect data from patients undergoing lung resection by VATS and analyze the cytopathological results of the collected material. RESULTS: A total of 47 endobag fluid samples were collected from patients who underwent VATS. The surgical specimen was subjected to histopathological analysis, and all patients underwent pathological TNM staging. In the cytopathological analyses, only 2 (4.3%) specimens of endobag fluid aspirate were positive for neoplastic cells. In these two cases, the tumors were peripheral, both with diagnoses of moderately differentiated adenocarcinoma and with classifications of T1bN0M0 and T3N0M0. These results indicate that although there is a low incidence of tumor cells in endobag fluid, it is always better to perform surgery using all available protective measures to avoid tumor implantation in the thoracic cavity to the greatest extent possible.

Individualized positive end-expiratory pressure in patients undergoing thoracoscopic lobectomy: a randomized controlled trial.

BACKGROUND AND OBJECTIVES: With the intensive study of lung protective ventilation strategies, people begin to advocate the individualized application of positive end-expiratory pressure (PEEP). This study investigated the optimal PEEP in patients during one-lung ventilation (OLV) and its effects on pulmonary mechanics and oxygenation. METHODS: Fifty-eight patients who underwent elective thoracoscopic lobectomy were randomly divided into two groups. Both groups received an alveolar recruitment maneuver (ARM) after OLV. Patients in Group A received optimal PEEP followed by PEEP decremental titration, while Group B received standard 5 cmH2O PEEP until the end of OLV. Relevant indexes of respiratory mechanics, pulmonary oxygenation and hemodynamics were recorded after entering the operating room (T0), 10 minutes after intubation (T1), pre-ARM (T2), 20 minutes after the application of optimal PEEP (T3), at the end of OLV (T4) and at the end of surgery (T5). Postoperative outcomes were also assessed. RESULTS: The optimal PEEP obtained in Group A was 8.8 ± 2.4 cmH2O, which positively correlated with BMI and forced vital capacity (FVC). Group A had a higher CPAT than Group B at T3, T4, T5 (p < 0.05) and a smaller ΔP than Group B at T3, T4 (p < 0.01). At T4, PaO2 was significantly higher in Group A (p < 0.01). At T3, stroke volume variation was higher in Group A (p < 0.01). Postoperative outcomes did not differ between the two groups. CONCLUSIONS: Our findings suggest that the individualized PEEP can increase lung compliance, reduce driving pressure, and improve pulmonary oxygenation in patients undergoing thoracoscopic lobectomy, with little effect on hemodynamics.

Resección de la primera costilla por videotoracoscopía en síndrome de Paget-Schroetter / Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome

Resumen El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget-Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.

Abstract Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to PagetSchroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.

[Resection of the first rib by video thoracoscopy in Paget-Schroetter syndrome]. / Resección de la primera costilla por videotoracoscopía en síndrome de Paget-Schroetter.

Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to Paget- Schroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.

El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget- Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.

Video-assisted thoracoscopic iodopovidone pleurodesis for malignant pleural effusions in moderate to high-risk Colombian patients.

Introduction: In developing countries where talc may not be readily available, video-assisted thoracoscopic (VATS) iodopovidone pleurodesis offers an excellent alternative for the treatment of malignant pleural effusions (MPEs). Methods: This study analyzes a retrospective experience using VATS iodopovidone pleurodesis for malignant pleural effusions at a single cardiothoracic center in the capital of Colombia evaluating success according to LENT (Lactate, Eastern Cooperative Oncology Group-ECOG, Neutrophil-Lymphocyte ratio, Tumor type) scores. A total of 75 records of patients taken to VATS iodopovidone pleurodesis for MPEs were retrieved from our institutional database during a 5-year period from 2014-2019. Of these, 45 had complete clinical history data necessary to analyze both LENT scores and post-op follow-up imaging. Results: Of the 45 patients evaluated, 93.3% (42 patients) had either complete resolution of pleural effusions or partial resolution with an asymptomatic recovery within the first month post op. Chest pain was the most common postoperative complaint, which was present in 20% of patients. The mean postoperative ECOG score was 2±1.7. Patients with moderate to high-risk LENT scores had success rates of 96.7% and 92.3% respectively. Conclusion: Video-assisted thoracoscopic pleurodesis using Iodopovidone-iodine is an effective approach for MPEs. In developing countries where Iodopovidone iodine is readily available and affordable, patients may benefit from this agent with excellent results and minimal complications.

[Will ultrasound replace the stethoscope?: a case report on neonatal one-lung ventilation]. / O ultrassom substituirá o estetoscópio?: relato de caso sobre ventilação monopulmonar neonatal.

BACKGROUND AND OBJECTIVES: One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position. CASE REPORT: We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound. CONCLUSION: US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.

Will ultrasound replace the stethoscope?: a case report on neonatal one-lung ventilation / O ultrassom substituirá o estetoscópio?: relato de caso sobre ventilação monopulmonar neonatal

Abstract Background and objectives: One-lung ventilation and selective intubation in neonates can be challenging due to intrinsic physiological specificities and material available. Ultrasound (US) is being increasingly used in many extents of anaesthesiology including confirmation of endotracheal tube position. Case report: We present a case report of a neonate proposed for pulmonary lobectomy by thoracoscopy in which lung exclusion was confirmed by ultrasound. Conclusion: US is a rapid, more sensitive and specific method than auscultation to evaluate tracheal intubation and lung exclusion.

Resumo Justificativa e objetivos: A ventilação monopulmonar e a intubação seletiva em recém-nascidos podem ser um desafio devido às especificidades fisiológicas intrínsecas e ao material disponível. O aparelho de ultrassom tem sido cada vez mais usado em muitas situações no campo da anestesia, incluindo a confirmação da posição do tubo endotraqueal. Relato de caso: Apresentamos o relato do caso de um recém-nascido proposto para lobectomia pulmonar por toracoscopia em que a exclusão pulmonar foi confirmada por ultrassom. Conclusão: O ultrassom é um método rápido, mais sensível e específico do que a ausculta para avaliar a intubação traqueal e a exclusão pulmonar.

Robot-assisted thoracic surgery in Colombia: a multi-institutional initial experience.

BACKGROUND: Robotic assisted videothoracoscopic surgery (RVATS) adoption has increased worldwide from 3.4% in 2010 to 17.5% in 2015. However, in Latin America, the literature is limited to a report of a series of 10 patients who underwent RVATS lobectomy and one case report of an RVATS thymectomy from Brazil. METHODS: This is a retrospective review of all RVATS performed in Bogotá Colombia since 2012. A single thoracic surgeon (RB) performed all the operations at three institutions: Clínica de Marly, Fundación Clínica Shaio and Instituto Nacional de Cancerología. Preoperative, intraoperative, postoperative and pathology report variables were included. Patients were analyzed in three groups: robotic RVATS pulmonary resections, RVATS mediastinal surgeries and other RVATS procedures. Descriptive statistics were used to report the median and interquartile range (IQR) of the continuous variables, and number and percentage were used to describe categorical variables. The association between total operative time and the year the surgery was analyzed using a linear regression model. RESULTS: Forty-seven patients underwent RVATS pulmonary resections; 72.3% (n=34) of these patients underwent a RVATS lobectomy. The median total operative time was 220 (IQR: 200 to 250) minutes, 6.4% (n=3) had intraoperative complications, and the most frequent histologic diagnosis was adenocarcinoma (n=24, 51.1%). Of 18 patients who underwent RVATS mediastinal surgeries, 50.0% (n=9) had RVATS thymectomy, the median total operative time was 195.5 (IQR: 131 to 221) minutes and two patients (11.1%) had intraoperative complications. The linear regression model of the association between total operative time and the year the surgery showed a 10.3 minute reduction per year (P=0.006). CONCLUSIONS: This is the second series of RVATS published in Latin America and the first published in Colombia, with comparable perioperative results to other reports.

Clear cell "sugar" tumor of the lung: a case report and review of the literature.

Clear cell "sugar" tumor of the lung is a rare benign tumor that is often an incidental finding during histopathologic workup. It strikingly has a similar resemblance to renal cell carcinoma (RCC) cells. Under the microscope, it is composed of thin cell walls and high levels of glycogen. Therefore, when diagnosed, it is important to rule out metastatic RCC. Here, in this case report, we present a case of clear cell "sugar" tumor of the lung and review the literature that has been published. Clear cell tumor of the lung needs to be studied more extensively as it can present with unique signs and symptoms. It has also occurred in the presence of systemic diseases. This has led researchers to theorize about its etiology which we discuss in this case report.

Trends in Hospital Treatment of Empyema in Children in the United States.

OBJECTIVE: To evaluate trends in procedures used to treat children hospitalized in the US with empyema during a period that included the release of guidelines endorsing chest tube placement as an acceptable first-line alternative to video-assisted thoracoscopic surgery. STUDY DESIGN: We used National Inpatient Samples to describe empyema-related discharges of children ages 0-17 years during 2008-2014. We evaluated trends using inverse variance weighted linear regression and characterized treatment failure using multivariable logistic regression to identify factors associated with having more than 1 procedure. RESULTS: Empyema-related discharges declined from 3 in 100 000 children to 2 in 100 000 during 2008-2014 (P = .04, linear trend). There was no significant change in the proportion of discharges having 1 procedure (66.1% to 64.1%) or in the proportion having 2 or more procedures (22.1% to 21.6%). The proportion coded for video-assisted thoracoscopic surgery as the only procedure declined (41.4% to 36.2%; P = .03), and the proportions coded for 1 chest tube (14.6% to 20.9%; P = .04) and 2 chest tube procedures (0.9% to 3.5%; P < .01) both increased. The median length of stay for empyema-related discharges remained unchanged (9.3 days to 9.8 days; P = .053). Having more than 1 procedure was associated with continuous mechanical ventilation (adjusted OR, 2.7; 95% CI, 1.8-4.1) but not with age, sex, payer, chronic conditions, transfer admission, hospital size, or census region. CONCLUSIONS: The use of video-assisted thoracoscopic surgery to treat children in the US hospitalized with empyema seems to be decreasing without associated increases in length of stay or need for additional drainage procedures.

Lobectomía pulmonar: ¿Qué beneficios ofrece la videotoracoscopía? / Pulmonary Lobectomy. What are the Benefits of Video-assisted Thoracoscopy?

Introducción: A pesar del creciente uso de la lobectomía por videotoracoscopía, este abordaje resulta aún controvertido en algunos aspectos. El objetivo del presente trabajo es comparar los resultados quirúrgicos de la lobectomía pulmonar por videotoracoscopía y por toracotomía. Material y métodos: En el Hospital Universitario Fundación Favaloro, entre los años 2008 y 2017, fueron intervenidos quirúrgicamente 153 pacientes (n = 89 masculinos). Resultados: Se realizó lobectomía por videotoracoscopía a 39/89 pacientes. Los pacientes intervenidos por videotoracoscopía y con diagnóstico de cáncer de pulmón, tenían predominantemente tumores en estadío I (25/39 pacientes). La incidencia de complicaciones postoperatorias y mortalidad fueron similares en ambos grupos. En el grupo intervenido por videotoracoscopía la permanencia del drenaje pleural fue significativamente menor (4 versus 3 días, p = 0.004) y, también resultó más breve la estadía hospitalaria (6 versus 4 días de internación, p = 0.03). El número de estaciones ganglionares exploradas durante la cirugía fue mayor en los pacientes operados por toracotomía (4 versus 3.5 estaciones ganglionares, p < 0.001). Conclusión: La lobectomía por videotoracoscopía resultó al menos equivalente a la cirugía por toracotomía en términos de complicaciones postoperatorias. Los principales beneficios del abordaje por videotoracoscopía fueron una menor permanencia del drenaje pleural y menor estadía hospitalaria. Se recomienda tener especial cuidado con el muestreo ganglionar cuando la cirugía se realiza por videotoracoscopía.

Introduction: Despite the widespread adoption of video-assisted thoracoscopic lobectomy, this surgical approach still remains controversial. The objective of this paper is to compare the surgical results of video-assisted thoracoscopic lobectomy to open thoracotomy lobectomy, performed at the Hospital Universitario Fundación Favaloro between 2008 and 2017. Materials and Methods: One-hundred and fifty three patients (n = 89 males) had surgery during the study period; 39/153 had video-assisted thoracoscopic lobectomy. Results: Patients that had video-assisted thoracoscopic lobectomy were more likely to have stage I lung cancer (25/39). Postoperative complications and mortality rates were similar in both groups. Video-assisted thoracoscopic lobectomy patients had a shorter chest tube drainage time (4 vs. 3 days, p = 0.004) and length of hospital stay (6 vs. 4 days of stay, p = 0.03). The median number of lymph node stations sampled at surgery was significantly higher in the patients that had open thoracotomy lobectomy (4 vs. 3.5 lymph node stations, p < 0.001). Conclusion: Video-assisted thoracoscopic lobectomy is at least equivalent to open thoracotomy lobectomy in terms of postoperative complications and mortality. The main benefits of the video-assisted thoracoscopic approach are a shorter chest tube drainage time and length of hospital stay. Special attention should be taken at the time of nodal sampling when the surgery is performed by the video-assisted thoracoscopic approach.

Hemotórax: etiología, diagnóstico, tratamiento y complicaciones / Hemothorax: etiology, diagnosis, treatment and complications

Resumen La sospecha de hemotórax inicia con una historia clínica adecuada, particularmente, el padecimiento actual, por ejemplo, casos con trauma torácico. El paso inicial de la evaluación es diferenciar los derrames pleurales hemorrágicos de los verdaderos hemotórax. Confirmar el diagnóstico de manera temprana es fundamental, dado que, conforme progresan las fases de organización del coágulo, se van desarrollando adherencias entre la superficie del parénquima pulmonar y la pleura parietal, aspecto que dificulta evacuarlo mediante drenaje pleural convencional. La radiografía de tórax continúa siendo el estudio complementario inicial, sin embargo, es importante realizar estudios adicionales que permitan orientar la decisión terapéutica; la elección del análisis paraclínico puede justificarse con base en la experiencia y disponibilidad de recursos en el centro de atención. La instalación del tratamiento primario es crucial e inicia con el drenaje de la cavidad torácica vía sonda pleural en la mayoría de los casos; el uso de fibrinolíticos se considera de segunda línea y particularmente en hemotórax coagulado o casos que tienen riesgos significativos de complicaciones al someterse a un procedimiento quirúrgico mayor (Por ejemplo. decorticación). Las complicaciones se pueden disminuir al sistematizar el enfoque diagnóstico-terapéutico.

Abstract Initial approach of cases with suspected hemothorax begins with a complete clinical history (eg. recent thoracic trauma). The first step is to differentiate hemorrhagic pleural effusion of true hemothorax; then, prompt diagnosis is essential. We must keep in mind, as time progresses, the clot firmly adheres to the lung and pleural surface making it difficult to treat; therefore, any delay in this process diminishes the opportunity to evacuate the hemothorax through conventional thoracostomy with chest tube insertion and pleural drainage. Chest X-ray still the initial study, however, complementary tests should be performed in order to guide therapeutic decisions. The choice must be justified on local availability and experience. Undoubtedly, primary evacuation is mandatory; fibrinolytics are reserved as second-line treatment, also can be considered in coagulated hemothorax or patients who are at a high risk of surgical complications. In order to diminish any morbidity it is advisable to perform a systematic diagnostic and therapeutic approach.

Single port training in Latin-America-first uniportal video-assisted thoracoscopic surgery masterclass in Santiago, Chile.

Video-assisted thoracoscopic surgery (VATS) surgery has become the standard technique in Thoracic Surgery since its introduction 20 years ago. Single port VATS appeared as the next step in its evolution, with rapid development since the first uniportal video-assisted thoracoscopic surgery lobectomy (VATS lobectomy) by Dr. Diego Gonzalez-Rivas. During the last 5 years, the approach has been simplified, standardized and taught in many countries, courses, live surgery and dedicated programs, with reproducible results. Hands-on courses represent the best way to learn a new surgical technique, as it shortens learning curves and decreases complications. We present the first training course in single port VATS in our country, which became the first hands course in Thoracic Surgery in Chile.

Uniportal video-assisted thoracoscopic right upper sleeve lobectomy.

BACKGROUND: The development of minimally invasive thoracic surgery in recent years is undeniable, VATS has evolved from the conventional three-port technique to an uniportal approach, without compromising the type of cases that can be operated successfully. METHODS: Thanks to the continuous progress of uniportal video-assisted thoracoscopic surgery (VATS) the complexity of cases performed by this approach has improved remarkably since the first procedures were made, recent advances in surgical thoracoscopic technology had made feasible to achieve vascular and bronchial sleeve lobectomies. Anatomic variants in patients can increase the technical difficulty of the procedure making the process more challenging. RESULTS: In this case the sleeve right upper lobectomy was performed by uniportal VATS despite the obstruction of the right pulmonary artery (PA) for the bronchial anastomosis. CONCLUSIONS: In the hands of experienced surgeons in uniportal VATS with background in thoracoscopic suturing, sleeve lobectomies are feasible and safe to perform even when anatomic variants increase the complexity of the case.