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Holder P, Bakeer MA. Robot-assisted repair of delayed traumatic diaphragmatic hernia: a case report. J Surg Case Rep 2024; 2024:rjae197. [PMID: 38572281 PMCID: PMC10987203 DOI: 10.1093/jscr/rjae197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 03/09/2024] [Indexed: 04/05/2024] Open
Abstract
Traumatic diaphragmatic hernia is a sign of severe thoracoabdominal trauma that is often difficult to detect because of nonspecific presenting symptoms, delayed presentation, and distracting injuries. Diagnosis depends on imaging and a high degree of suspicion in patients who present with respiratory or gastrointestinal symptoms after trauma, and prompt surgical repair is required. This case reviews a patient who presented to the emergency department with burning epigastric pain radiating to the left chest and hematemesis ~1 month after sustaining a blunt abdominal injury. Imaging studies revealed a substantial portion of the gastric body in the left hemithorax. Robot-assisted reduction of the stomach was performed followed by repair with tension-free primary closure without mesh reinforcement and gastropexy. The patient was monitored for return of bowel function and discharged upon recovery. This case report highlights the diagnostic challenges of traumatic diaphragmatic hernia and the benefit of robot-assisted repair.
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Affiliation(s)
- Paxton Holder
- Department of Clinical Affairs, Edward Via College of Osteopathic Medicine, Monroe, LA, United States
| | - Mohamed-Aly Bakeer
- The Surgery Clinic of Northeast Louisiana and the Department of Surgery at Saint Francis Medical Center, Monroe, LA, United States
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2
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Pang J, Xiu W, Ma X. Application of Artificial Intelligence in the Diagnosis, Treatment, and Prognostic Evaluation of Mediastinal Malignant Tumors. J Clin Med 2023; 12:jcm12082818. [PMID: 37109155 PMCID: PMC10144939 DOI: 10.3390/jcm12082818] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Artificial intelligence (AI), also known as machine intelligence, is widely utilized in the medical field, promoting medical advances. Malignant tumors are the critical focus of medical research and improvement of clinical diagnosis and treatment. Mediastinal malignancy is an important tumor that attracts increasing attention today due to the difficulties in treatment. Combined with artificial intelligence, challenges from drug discovery to survival improvement are constantly being overcome. This article reviews the progress of the use of AI in the diagnosis, treatment, and prognostic prospects of mediastinal malignant tumors based on current literature findings.
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Affiliation(s)
- Jiyun Pang
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Weigang Xiu
- Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Medicine, Sichuan University, Chengdu 610041, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
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Al Zaidi M, Wright GM, Yasufuku K. Suggested robotic-assisted thoracic surgery training curriculum. J Thorac Dis 2023; 15:791-798. [PMID: 36910116 PMCID: PMC9992622 DOI: 10.21037/jtd-22-598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/05/2022] [Indexed: 02/18/2023]
Abstract
Robotic-assisted surgery, a technological advancement in the field of surgery, has become increasingly popular among surgeons of many specialties over time. Robotic-assisted thoracic surgery (RATS) is comparable to video-assisted thoracic surgery (VATS) in terms of patient care outcomes; however, the perception of increased operative time and a lack of cost-effectiveness have led to controversy regarding its alleged benefits. Nevertheless, robotic surgery is one of the preferred options for minimally invasive surgery by some thoracic surgeon over VATS, due to its ability to provide 3-D vision, precise wrist movements, enhanced magnification, and instrument stability and articulation. Notably, trainees in the field of thoracic surgery experience difficulty gaining knowledge and learning skills associated with RATS due to its complexity, limited access to robotic instruments, the lack of a standardized curriculum for trainees, and lack of mentorship or proctorship, thus leading to a steeper learning curve compared to laparoscopic or VATS procedures that are cost-friendly, easy to learn, and feasible to practice. Nevertheless, focusing on RATS training for thoracic surgeons will keep them familiar with robotic techniques, including the pre-operative setup and intra-operative process, which will ultimately decrease operative times. In this paper, we will review the literature, express and discuss the most viable training curriculum from authors' point of view to help achieve this goal.
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Affiliation(s)
- Muteb Al Zaidi
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Division of Thoracic Surgery, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Gavin M Wright
- St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
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4
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Robotic Mediastinal Surgery. Thorac Surg Clin 2023; 33:89-97. [DOI: 10.1016/j.thorsurg.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mediastinal Parathyroid Cancer. Cancers (Basel) 2022; 14:cancers14235852. [PMID: 36497335 PMCID: PMC9739626 DOI: 10.3390/cancers14235852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Parathyroid cancer (PC) is rare, but its pre-operative recognition is important to choose appropriate access strategies and achieve oncological clearance. This study characterizes features of mediastinal parathyroid cancer (MPC) and explores criteria aiding in the pre-operative recognition of malignancy. We assembled data from 502 patients with mediastinal parathyroid neoplasms (MPNs) from a systematic review of the literature 1968−2020 (n = 467) and our own patient cohort (n = 35). Thirty-two of the 502 MPNs (6.4%) exhibited malignancy. Only 23% of MPC patients underwent oncological surgery. Local persistence and early recurrence at a median delay of 24 months were frequent (45.8%), and associated with a 21.7-fold (95%CI 1.3−351.4; p = 0.03) higher risk of death due to disease. MPCs (n = 30) were significantly larger than cervical PC (n = 330), at 54 ± 36 mm vs. 35 ± 18 mm (χ2 = 20; p < 0.0001), and larger than mediastinal parathyroid adenomas (MPA; n = 226) at 22 ± 15 mm (χ2 = 33; p < 0.01). MPC occurred more commonly in males (60%; p < 0.01), with higher calcium (p < 0.01) and parathyroid hormone (PTH) levels (p < 0.01) than MPA. Mediastinal lesions larger than 3.0 cm and associated with a corrected calcium ≥ 3.0 mM are associated with a more than 100-fold higher odds ratio of being malignant (OR 109.2; 95%CI 1.1−346; p < 0.05). The composite 3 + 3 criterion recognized 74% of all MPC with an accuracy of 83%. Inversely, no MPN presenting with a calcium < 3.0 mM and size < 3.0 cm was malignant. When faced with pHPT in mediastinal location, consideration of the 3 + 3 rule may trigger an oncological team approach based on simple, available criteria.
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Aresu G, Dunning J, Routledge T, Bagan P, Slack M. OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6567558. [PMID: 35413097 PMCID: PMC9422751 DOI: 10.1093/ejcts/ezac178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/18/2022] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giuseppe Aresu
- Cardiothoracic Surgical Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Joel Dunning
- Department of Thoracic Surgery, James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - Tom Routledge
- Department of Thoracic Surgery, Guy’s and St Thomas' NHS Foundation Trust, London, UK
| | - Patrick Bagan
- Department of Thoracic and Vascular Surgery, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Mark Slack
- CMR Surgical, Cambridge, UK
- Corresponding author. CMR Surgical Ltd, 1 Evolution Business Park, Milton Road, Cambridge CB24 9NG. Tel: +44 (0)1223 755300; e-mail: (M. Slack)
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Sideris AC, Molena D. Robotic transthoracic diaphragmatic hernia repair. JTCVS Tech 2021; 10:578-580. [PMID: 34977813 PMCID: PMC8691652 DOI: 10.1016/j.xjtc.2021.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022] Open
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Shahin GM, Topal B, Pouwels S, Markou TL, Boon R, Stigt JA. Quality assessment of robot assisted thoracic surgical resection of non-small cell lung cancer: nodal upstaging and mediastinal recurrence. J Thorac Dis 2021; 13:592-599. [PMID: 33717532 PMCID: PMC7947478 DOI: 10.21037/jtd-20-2267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Robot assisted thoracic surgery (RATS) is the minimally invasive surgical technique of choice for treatment of patients with non-small cell lung cancer (NSCLC), at the Isala Hospital. The aim of this study is to compare clinical and pathological staging results and mediastinal recurrence after RATS for anatomical resections of lung cancer as surrogate markers for quality of mediastinal lymph node dissection (MLND). Methods This single institute retrospective study was conducted in patients who underwent RATS for NSCLC. Excluded were patients with a history of concurrent malignant disease, with other previous neoplasms, with small cell lung cancer (SCLC) and patients in whom the robotic technique was converted to thoracotomy, prior to lymph node dissection. Data were obtained from the hospital database. The difference between clinical and pathological staging was expressed as upstaging and downstaging. Computed Tomography scanning was used for follow-up, and diagnosis of mediastinal recurrence. Results From November 2011 to May 2016, 227 patients underwent RATS at Isala Hospital Zwolle, the Netherlands. Of those, 130 (mean age, 69.5±9.3 years) met the eligibility criteria. Preoperative mediastinal lymph node staging was done by endoscopic ultrasound/endobronchial ultrasound, by positron emission tomography (PET) or mediastinoscopy. In 14 patients (10.8%) unforeseen N2 disease was found, 6 patients (4.6%) were upstaged from cN0 to pN2 and 8 patients (6.2%) were upstaged from cN1 to pN2. Mediastinal recurrence was detected in 7 patients (5.4%) during a median follow-up of 54 months (range, 1.5-102 months). Conclusions In patients with NSCLC, who underwent anatomical resection by means of RATS, an unforeseen N2 disease rate of 10.8% was demonstrated and a mediastinal recurrence rate of 5.4%. It is concluded that robotic surgery provides an accurate lymph node dissection.
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Affiliation(s)
- Ghada M Shahin
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Besir Topal
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Sjaak Pouwels
- Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, The Netherlands
| | - Thanasie L Markou
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Rody Boon
- Department of Cardiothoracic Surgery, Isala Heart Center, Zwolle, The Netherlands
| | - Jos A Stigt
- Department of Pulmonology, Isala, Zwolle, The Netherlands
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Joshi V, Dimarakis I. Objective analysis of postoperative air leaks can aid in decision-making, but does the use of digital drains really impact patient outcomes? J Thorac Dis 2020; 12:3927-3929. [PMID: 32944301 PMCID: PMC7475533 DOI: 10.21037/jtd.2020.04.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Vijay Joshi
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK
| | - Ioannis Dimarakis
- Department of Cardiothoracic Surgery, Wythenshawe Hospital, Manchester, UK.,Division of Cardiovascular Sciences, University of Manchester, Manchester, UK
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Rodriguez M, Ferrari-Light D, Wee JO, Cerfolio RJ. The need for structured thoracic robotic training: the perspective of an American Association for Thoracic Surgery surgical robotic fellow. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:557. [PMID: 32775358 PMCID: PMC7347782 DOI: 10.21037/atm.2020.03.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Maria Rodriguez
- Department of Thoracic Surgery, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Jon O Wee
- Division of Thoracic Surgery, Brigham and Women´s Hospital, Boston, MA, USA
| | - Robert J Cerfolio
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY, USA
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Fazekas L, Ghimessy Á, Gieszer B, Radeczky P, Mészáros L, Török K, Bogyó L, Hartyánszky I, Pólos M, Daróczi L, Agócs L, Kocsis Á, Bartók T, Dancs T, Tóth KK, Schönauer N, Madurka I, Elek J, Döme B, Rényi-Vámos F, Lang G, Farkas A. Lung Transplantation in Hungary From Cardiac Surgeons' Perspective. Transplant Proc 2019; 51:1263-1267. [DOI: 10.1016/j.transproceed.2019.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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12
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Shahin GMM, Brandon Bravo Bruinsma GJ, Stamenkovic S, Cuesta MA. Training in robotic thoracic surgery-the European way. Ann Cardiothorac Surg 2019; 8:202-209. [PMID: 31032203 DOI: 10.21037/acs.2018.11.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The increasing demand for robot-assisted thoracic surgery (RATS) in Europe requires a structured and standardized training module. Until now, Intuitive Surgical Inc. (Sunnyvale, CA, USA) has delivered the only available robotic surgery platform. Although the training program that is organized by Intuitive is divided in an initial and an advanced course, the success of the training depends on many external factors. Until now the training focused on experienced thoracic surgeons. The aim of this article is to offer a stepwise training module, which can be adopted by experienced open (thoracotomy) surgeons or video-assisted thoracic (VATS) surgeons but is primarily meant for thoracic surgery fellows and residents, as it is our sincere opinion that we should focus on training for this type of surgery as early in their careers as possible. In order to maintain surgical technique and minimize the chance of complications, on-going training and certification of the surgeons and the team is deemed necessary.
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Affiliation(s)
- Ghada M M Shahin
- Department of Cardiothoracic Surgery, Isala Heart Centre, Zwolle, The Netherlands
| | | | | | - Miguel A Cuesta
- Department of General Surgery, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands
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