Cardiothoracic Surgery
Since the 1960s mesothelioma has been gaining interest world-wide as a result of its increasing incidence, related medico-legal issues and poor prognosis. Pleural cancer can rapidly prove fatal, as it has five and ten year relative survival rates of 6.8% and 2.5% respectively. Most mesotheliomas are due to exposure to asbestos, with 80%-85% of cases being attributable to occupational exposure. It has been estimated that, between 1994 and 2008, age‐adjusted mesothelioma mortality rates increased by 5.37% per year worldwide. Because the asbestos bans and regulations went into effect during different times in different countries, it is expected that mesothelioma rates will follow dissimilar patterns in the next decades. By 1990, the use of asbestos in most industrialized countries had been reduced by at least 75% from the peak asbestos consumption Mesotheliomas may be caused by environmental exposure, genetic predisposition, or genetic + environmental interaction. Pathogenic germline mutations of BAP1 and, less frequently, of other tumor suppressor genes have been detected in approximately 12% of patients2. Malignant mesotheliomas are tumours which originate from the mesothelial cells. Most commonly, it originates from the pleura, however, it can originate virtually from any mesothelial structure. There are 3 histological subtypes: epithelial, sarcomatoid and biphasic. The latter shows characteristics of both and the sarcomatoid is the one with the worse prognosis. The clinical manifestations are generally subtle and tend to present once disease is already at an advanced stage. The most common symptoms are weight loss, dyspnoea, chest pain and dry cough. On physical examination the patient may show clubbing and signs of pleural effusion. In patients with MPM an accurate staging is fundamental in order to carefully select patients who will benefit from a radical treatment. In this class we will talk in depth about the minimally invasive staging of MPM. Multidisciplinary international collaboration will be necessary to improve prevention, early detection, and treatment.
Published
Feb 2021
In the last ten years, thoracic surgery has evolved into a less invasive approach ito perform safe and effective procedures with minimal trauma to the patient. Minimally invasive thoracic surgery has become the treatment of choice for thoracic tumors. 90% of resections in thoracic surgery are performed to remove a lung, mediastinal or pleural malignant tumor, so a minimally invasive approach must meet three conditions: being safe, being feasible, and making complete resection of the tumor possible. The development of specific minimally invasive thoracic surgery instruments and a higher experience of surgical teams in minimally invasive approaches has made it possible to perform tumor resection through a transcervical, transthoracic or subxiphoid approach. This makes it possible to perform the same resection than open surgery with less trauma to the patient. In this presentation we describe different thoracic approaches depending on the location and number of the incisions and the instruments used.
Published
Jun 2020
Anatomical knowledge of the organs we will be operating on is crucial to have good results and to avoid accidents during surgery. Inter-individual differences make this knowledge even more important in thoracic surgery. Lung resection is a surgical procedure in which a section of a lung or the entire lung is removed. It usually involves removal of a small or large section of the lung (lobectomy or segmentectomy) or removal the entire lung (pneumonectomy). Lymph nodes and some surrounding tissue around the lung area may also be removed. In the first two decades of the 20th century, tuberculosis and bronchiectasis were the main indications for lobar resections but these days the main reason for needing a lung resection is lung cancer. Other lung diseases such as lung infections or emphysema are less prevalent but they are still an important portion of lung surgery. Lung resections were performed classically by open surgery (thoracotomy) but now minimally invasive surgery (Video-Assisted Thoracic Surgery - VATS) has become the gold standard due to its lesser aggression and its comparable results. Lung resection is a major operation commonly performed under general anesthesia with a double lumen tube. In this video we describe the anatomy of the lung and briefly review the different types of lung resection.
Published
Apr 2020
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