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Thoracic Surgery Clinics Nov 2017Several minimally invasive approaches for esophagectomy have been described, including robot-assisted esophagectomy and hybrid techniques, total transhiatal laparoscopic... (Review)
Review
Several minimally invasive approaches for esophagectomy have been described, including robot-assisted esophagectomy and hybrid techniques, total transhiatal laparoscopic approach, esophagectomy using right thoracoscopy, combined laparoscopic and right thoracoscopic esophagectomy, and esophageal resection through mediastinoscopy. However, very few publications have focused on the uniportal video-assisted thoracic surgery (VATS) approach. The authors describe their technique of the minimally invasive esophagectomy using uniportal VATS as the thoracic step.
Topics: Esophageal Neoplasms; Esophagectomy; Esophagus; Humans; Minimally Invasive Surgical Procedures; Thoracic Surgery, Video-Assisted
PubMed: 28962713
DOI: 10.1016/j.thorsurg.2017.06.009 -
Chest May 2015The purpose of this article is to provide an update on evidence-based methods for mediastinal staging in patients with lung cancer. This is a review of the recently... (Review)
Review
The purpose of this article is to provide an update on evidence-based methods for mediastinal staging in patients with lung cancer. This is a review of the recently published studies and a summary of relevant guidelines addressing the role of CT scan, PET scan, endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA), and mediastinoscopy as pertinent to lung cancer staging and restaging. The focus is on how these diagnostic methods fit into the best algorithm for patients with chest imaging abnormalities suspected of malignant disease. Several studies, meta-analyses, and systematic reviews specifically targeted the role of PET scan, EBUS-TBNA, and mediastinoscopy for detecting mediastinal lymph node involvement in patients suffering from lung cancer. Based on the recommendations from the currently published guidelines, algorithms of care are proposed for staging and restaging of the mediastinum.
Topics: Algorithms; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Lung Neoplasms; Mediastinal Neoplasms; Neoplasm Invasiveness; Neoplasm Staging; Positron-Emission Tomography; Tomography, X-Ray Computed
PubMed: 25940251
DOI: 10.1378/chest.14-1355 -
The Journal of the Association of... Sep 2015Mediastinoscopy is a minimally invasive surgical procedure that allows visualization and tissue sampling of mediastinal nodes. Mediastinoscopy has been extremely...
Mediastinoscopy is a minimally invasive surgical procedure that allows visualization and tissue sampling of mediastinal nodes. Mediastinoscopy has been extremely valuable in the evaluation and staging of lung cancer and therefore has been considered the gold standard for this purpose for over 30 years. Historically, this procedure has been associated with a low morbidity and mortality and a high sensitivity for diagnosing lung cancer with certain procedural limitations. Recently, it has been reported that not only is mediastinoscopy use limited in community practice, concomitant biopsy rates are limited as well.1 While mediastinoscopy does provide a tissue diagnosis, the procedure has its limitations. Cervical mediastinoscopy allows access to nodal stations 2, 3, 4 and 7, leaving out commonly involved pulmonary ligament and aortopulmonary window nodes.1 It requires general anesthesia and has a morbidity of 1% and a mortality of 0.2%. The procedure adds considerable expense to the staging workup. The estimated current cost is $1,700 for the procedure alone and $7,500 for a mediastinoscopy with a 2-day hospital stay. This prompted the development of endobronchial ultrasound(EBUS) in the 1990s.2.
PubMed: 27608860
DOI: No ID Found -
Journal of Thoracic Disease Aug 2018Preoperative mediastinal staging is crucial in the management of patients with non-small cell lung cancer (NSCLC), especially to define prognosis and the most proper... (Review)
Review
Preoperative mediastinal staging is crucial in the management of patients with non-small cell lung cancer (NSCLC), especially to define prognosis and the most proper treatment. To obtain the highest certainty level before lung resection, the current American and European guidelines for preoperative mediastinal nodal staging for NSCLC recommend getting tissue confirmation of regional nodal spread in all cases except in patients with small (≤3 cm) peripheral carcinomas with no evidence of nodal involvement on computed tomography (CT) and positron emission tomography (PET). We have a wide variety of surgical methods for mediastinal staging that are well integrated in the current preoperative algorithms. Their main indication is the validation of negative results obtained by minimally invasive endoscopic techniques. However, recent studies have reported the superiority of mediastinoscopy over endosonography methods in terms of accuracy for those tumours classified as clinical (c) N0-1 by CT and PET or with intermediate risk of N2 disease (cN1 and central tumours). Apart from the exploration of the mediastinum, other surgical procedures [parasternal mediastinotomy, extended cervical mediastinoscopy (ECM) and video-assisted thoracoscopic surgery (VATS)] allow the completion of the staging process with the assessment of the primary tumour and metastasis, exploring the lung, pleural cavity, and pericardium when it is required. Transcervical lymphadenectomies represent the evolution of mediastinoscopy and they are already considered the most reliable method for mediastinal staging, mainly in the subgroup of patients in whom endosonography methods have a low sensitivity: tumours with normal mediastinum by CT and PET. In addition to their indication for staging, these procedures have also demonstrated to be feasible as preresectional lymphadenectomy in VATS lobectomy, improving the radicality of the number of lymph nodes and lymph node stations explored, mostly for left-sided tumours for which a complete mediastinal nodal dissection is not always possible by VATS approach.
PubMed: 30345097
DOI: 10.21037/jtd.2018.03.183 -
Saudi Journal of Anaesthesia 2021The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications... (Review)
Review
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
PubMed: 34764836
DOI: 10.4103/sja.SJA_350_20 -
Radiologic Clinics of North America May 2018This article reviews regional lymph node assessment in lung cancer. In the absence of a distant metastasis, the absence or location of lung cancer spread to a regional... (Review)
Review
This article reviews regional lymph node assessment in lung cancer. In the absence of a distant metastasis, the absence or location of lung cancer spread to a regional mediastinal lymph node affects treatment options and prognosis. Regional lymph node maps have been created to standardize assessment of the N descriptor. The International Association for the Study of Lung Cancer lymph node map is used for the standardization of N descriptor assessment. CT, PET/CT with fluorodeoxyglucose, endobronchial ultrasound-guided and/or esophageal ultrasound-guided biopsy, and mediastinoscopy are common modalities used to determine the N descriptor.
Topics: Humans; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Tomography, X-Ray Computed
PubMed: 29622075
DOI: 10.1016/j.rcl.2018.01.008 -
Chest Mar 2020There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to...
BACKGROUND
There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort.
METHODS
We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis.
RESULTS
Among 30,570 patients, 49% underwent EBUS. Severe adverse events-pneumothorax, hemothorax, airway/vascular injuries, or death-were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776).
CONCLUSIONS
When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.
Topics: Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Health Care Costs; Health Expenditures; Hemothorax; Humans; Lung Neoplasms; Lymph Nodes; Male; Mediastinoscopy; Middle Aged; Mortality; Neoplasm Staging; Pneumothorax; Postoperative Complications; Respiratory System; Retrospective Studies; Vascular System Injuries; Vocal Cord Paralysis
PubMed: 31605700
DOI: 10.1016/j.chest.2019.09.021 -
World Journal of Surgical Oncology Aug 2021To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a...
BACKGROUND
To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique.
METHODS
Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect.
RESULTS
There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed.
CONCLUSIONS
Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Lymph Node Excision; Mediastinoscopy; Neoplasm Recurrence, Local; Prognosis; Technology
PubMed: 34364369
DOI: 10.1186/s12957-021-02352-w -
Current Opinion in Anaesthesiology Aug 2020This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications. (Review)
Review
PURPOSE OF REVIEW
This article provides an overview of standard procedures currently performed in nonoperating room anesthesia (NORA) and highlights anesthetic implications.
RECENT FINDINGS
Novel noninvasive interventional procedures remain on the rise, accelerating demand for anesthesia support outside the conventional operating room. The field of interventional oncology has introduced a variety of effective minimally invasive therapies making interventional radiology gain a major role in the management of cancer. Technical innovation brings newer ablative and embolotherapy techniques into practice. Flexible bronchoscopy has replaced rigid bronchoscopy for many diagnostic and therapeutic indications. Endobronchial ultrasonography now allows sampling of mediastinal, paratracheal, or subcarinal lymph nodes rendering more invasive procedures such as mediastinoscopy unnecessary. Similarly, endoscopic ultrasonosgraphy currently plays a central position in the management of gastrointestinal disease. Sophisticated catheter techniques for ablating cardiac arrhythmias have become state of the art; Watchman procedure gaining position in the prevention of stroke resulting from atrial fibrillation.
SUMMARY
NORA is a rapidly evolving field in anesthesia. Employing new technology to treat a wide variety of diseases brings new challenges to the anesthesiologist. Better understanding of emerging interventional techniques is key to safe practice and allows the anesthesia expert to be at the forefront of this swiftly expanding multidisciplinary arena.
Topics: Anesthesia; Anesthesiologists; Anesthesiology; Bronchoscopy; Catheterization; Endoscopy; Gastroenterology; Humans; Pulmonary Medicine; Radiology, Interventional; Ultrasonography
PubMed: 32628401
DOI: 10.1097/ACO.0000000000000898 -
The Thoracic and Cardiovascular Surgeon Jan 2023The coexistence of pleural and pericardial effusions in frail patients with or without confirmed neoplasia necessitates the use of a minimally invasive technique that...
The coexistence of pleural and pericardial effusions in frail patients with or without confirmed neoplasia necessitates the use of a minimally invasive technique that has a minor impact on the patient's general status and allows for fast fluid evacuation and biopsy sampling if necessary. We present a subxiphoid mediastinoscopic autonomous (simultaneous noncommunicating) double fenestration approach for these patients with both diagnostic and therapeutic advantages in selected cases. Using the mediastinoscope alone through the subxiphoid incision can considerably reduce the duration of operation, allow for fluid evacuation, and significantly alleviate the patient's symptoms. This method enables the sampling of pleural and pericardial fluids and targeted tissue, if necessary.
Topics: Humans; Mediastinoscopes; Treatment Outcome; Pericardial Effusion; Mediastinoscopy; Biopsy
PubMed: 36216329
DOI: 10.1055/s-0042-1757177