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Thoracoscopic thymectomy using a subxiphoid camera port
Thoracoscopic thymectomy is currently considered the approach of choice for the treatment of thymic conditions, including myasthenia gravis (MG). It has demonstrated advantages over open approaches, because it reduces postoperative pain, hospital stay, blood loss, promotes early patient discharge, and provides cosmetic improvement. The use of a subxiphoid access, either as a single port or camera-assistant port, grants even greater benefits as it allows the following: visualization of the phrenic nerve to the contralateral phrenic nerve, reaching all the thymus poles and the lower limit of the thyroid gland, peritracheal fat and aortopulmonary window, pericardial dissection and bilateral epiphrenic fat removal. In addition, it facilitates bilateral exploration through a pleural opening without the need to place another trocar on the left, and the use of carbon dioxide throughout the surgery, thereby avoiding sternal retraction. The dissection through the correct planes, and the systematization of the operative technique might reduce time and improve outcomes.
I Sastre, M España, R Ceballos, M Bustos
Surgical intervention
2 months ago
1283 views
18 likes
4 comments
08:10
Thoracoscopic thymectomy using a subxiphoid camera port
Thoracoscopic thymectomy is currently considered the approach of choice for the treatment of thymic conditions, including myasthenia gravis (MG). It has demonstrated advantages over open approaches, because it reduces postoperative pain, hospital stay, blood loss, promotes early patient discharge, and provides cosmetic improvement. The use of a subxiphoid access, either as a single port or camera-assistant port, grants even greater benefits as it allows the following: visualization of the phrenic nerve to the contralateral phrenic nerve, reaching all the thymus poles and the lower limit of the thyroid gland, peritracheal fat and aortopulmonary window, pericardial dissection and bilateral epiphrenic fat removal. In addition, it facilitates bilateral exploration through a pleural opening without the need to place another trocar on the left, and the use of carbon dioxide throughout the surgery, thereby avoiding sternal retraction. The dissection through the correct planes, and the systematization of the operative technique might reduce time and improve outcomes.
Standardized steps for robotic right upper lung lobectomy
Video-assisted thoracoscopic surgery has been accepted as a safe and effective technique for the treatment of non-small cell lung cancer. The robot-assisted technologies have been rapidly applied to general thoracic surgery and many studies have proven their efficacy.
This video reports the case of a 64-year-old patient complaining of cough and mild dyspnea secondary to a double nodule localized on the right upper lobe and which showed fixations on PET-scan. There was also a fixation of a hilar lymph node with a clinical T3N1 disease according to the TNM staging system. We report the 4 standardized operative steps and exposure required to make a complete robotic right upper lobectomy, along with trocars positioning, the different techniques for lymph node dissections, and postoperative outcomes.
JM Baste, Z Chaari
Surgical intervention
3 months ago
667 views
13 likes
1 comment
07:57
Standardized steps for robotic right upper lung lobectomy
Video-assisted thoracoscopic surgery has been accepted as a safe and effective technique for the treatment of non-small cell lung cancer. The robot-assisted technologies have been rapidly applied to general thoracic surgery and many studies have proven their efficacy.
This video reports the case of a 64-year-old patient complaining of cough and mild dyspnea secondary to a double nodule localized on the right upper lobe and which showed fixations on PET-scan. There was also a fixation of a hilar lymph node with a clinical T3N1 disease according to the TNM staging system. We report the 4 standardized operative steps and exposure required to make a complete robotic right upper lobectomy, along with trocars positioning, the different techniques for lymph node dissections, and postoperative outcomes.
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
A Boutin, M Sarsam, M Lair, N Piton, C Peillon, JM Baste
Surgical intervention
3 years ago
983 views
66 likes
1 comment
07:38
Complex robotic resection of a large middle mediastinal thymoma
A 62-year-old man had an asymptomatic middle mediastinal tumor with a 4.5cm diameter, opposite to the superior vena cava and the azygos vein in the Barety’s space, which was discovered on thoracic CT-scan performed during an urothelial tumor follow-up.
Past history includes an urothelial carcinoma grade I treated with transurethral cystectomy, an ischemic cardiopathy with a single medical treatment, a prostate hypertrophy, and a sigmoid diverticulosis.
After a multidisciplinary review of the case, a mediastinoscopy was performed. It demonstrated the presence of a thymoma.
The patient was well informed of the operative risks and of the possibility of conversion, but thanks to our experience and national recommendations, we were able to perform a radical robotic assisted thymectomy.
The operation took during 3 hours with less than 100cc of bleeding.
The postoperative course was uneventful and the patient was discharged on postoperative day 3.
Histopathological analysis showed a type AB thymoma according to the OMS 2015 classification. The staging was IIb according to Masaoka. No adjuvant radiotherapy was indicated.
Right upper lobectomy: how I do it?
The anterior approach to right upper lobectomies is the most standard one, although it is not always the easiest one. As stressed by Dr. Baste, anterior dissection of the hilum can be hazardous and requires attention. Based on demonstrative pictures and videos, Dr. Baste outlines the global preoperative and intraoperative approach used routinely at Rouen’s Teaching Hospital. The description of the technique is mainly inspired from the Danish team (Hansen et al., Surgical Endoscopy). Surgical safety is one of the key objectives of this approach with preventative methods and intraoperative management techniques in case of injury. Preoperatively, CT-scan analysis is highlighted and patient set-up is described.
The intraoperative step is also described meticulously, and notably the D-zone, which represents the most dangerous zone during the resection.
JM Baste
Lecture
3 years ago
1465 views
94 likes
0 comments
13:30
Right upper lobectomy: how I do it?
The anterior approach to right upper lobectomies is the most standard one, although it is not always the easiest one. As stressed by Dr. Baste, anterior dissection of the hilum can be hazardous and requires attention. Based on demonstrative pictures and videos, Dr. Baste outlines the global preoperative and intraoperative approach used routinely at Rouen’s Teaching Hospital. The description of the technique is mainly inspired from the Danish team (Hansen et al., Surgical Endoscopy). Surgical safety is one of the key objectives of this approach with preventative methods and intraoperative management techniques in case of injury. Preoperatively, CT-scan analysis is highlighted and patient set-up is described.
The intraoperative step is also described meticulously, and notably the D-zone, which represents the most dangerous zone during the resection.
Alternative fissureless technique: VATS ‘tunnel’ and ‘fissure first’ technique with staplers
Over the last years, the fissureless technique for thoracoscopic major pulmonary resections has become very popular. In this technique, the surgeon does not care about the fissure and its contents and staples it “en bloc” at completion of the lobectomy. The main advantage is its relative ease and rapidity. However, some anatomical variations make this technique hazardous and some surgeons do prefer a “fissure-based” technique with first dissection of vascular elements in the fissure. When the fissure is fused, this technique is difficult and can lead to troublesome oozing and postoperative air leaks. In these cases, the “tunnel technique”, which is presented here by Dr. Decaluwe, is very helpful.
H Decaluwe
Lecture
3 years ago
864 views
43 likes
0 comments
15:00
Alternative fissureless technique: VATS ‘tunnel’ and ‘fissure first’ technique with staplers
Over the last years, the fissureless technique for thoracoscopic major pulmonary resections has become very popular. In this technique, the surgeon does not care about the fissure and its contents and staples it “en bloc” at completion of the lobectomy. The main advantage is its relative ease and rapidity. However, some anatomical variations make this technique hazardous and some surgeons do prefer a “fissure-based” technique with first dissection of vascular elements in the fissure. When the fissure is fused, this technique is difficult and can lead to troublesome oozing and postoperative air leaks. In these cases, the “tunnel technique”, which is presented here by Dr. Decaluwe, is very helpful.
Bronchoscopy for thoracic surgeons
The idea of this lecture originated from the fact that there is very little teaching material which described bronchoscopy as practiced by the thoracic surgeon. Chest physicians (pulmonologists) perform flexible bronchoscopy on a sedated patient, and they get up-side-down views to that obtained by the surgeons. Bronchoscopy at our department is performed under general anaesthesia, usually in the anaesthetic room just before the operation. We introduce a rigid bronchoscope first, and then a flexible fibre optic 5mm bronchoscope through the rigid scope into the trachea. This arrangement enables precise diagnosis due to excellent vision, with the ability to transform the procedure into a therapeutic session, for example, to take large biopsies, and decide to laser a lesion or to put in a central airway stent. Controlled breathing makes it safer to control significant bleeding during the procedure, and it is understandable that chest physicians shy away from biopsying carcinoid tumours.
The video is divided into 6 chapters. Chapter one deals with the identification of the bronchopulmonary segments and a bit of history about the two systems of nomenclature. It describes in a simplified way the effects of the heart growing in the left chest and the results of fusion, rotation and delayed branching of bronchi. Chapter 2 deals with normal bronchoscopy and anatomy of trachea, main bronchi, and segmental bronchi. Chapter 3 deals with abnormalities of the upper airways and trachea. Chapter 4 deals with abnormalities of the right bronchial tree, and chapter 5 deals with abnormalities of the left bronchial tree. The emphasis is on surgical pathology, assessment of airway for resection and decision-making. The viewer is encouraged to take the test on chapter 6 to bolster his/her knowledge of the anatomy of the airways.

1. Objectives:
a. To identify the bronchopulmonary segments in a logical and easy way to recall.
b. To understand the embryological changes resulting from heart growing into left chest.
c. To state what the operator should look for, what is normal and what is abnormal.
d. To help decision-making at operation and in the perioperative period.

2. For whom is this video made:
a. Consultants and trainees in the specialty of cardiothoracic surgery, including paediatric thoracic surgeons.
b. Thoracic and general anaesthetists who are involved with single lung ventilation.
c. Chest physicians who perform bronchoscopy, to understand views and capabilities of flexible over rigid bronchoscopy, and to have a gist of what goes on the mind of a thoracic surgeon when performing bronchoscopy.
d. Intensivists who might perform bronchoscopy via an endotracheal tube for a ventilated patient in the intensive care unit (ICU).
e. Medical students interested in the detailed anatomy of the central airways.

3. What this video is not intended to do:
a. This is not a compendium of abnormalities and pathologies revealed by bronchoscopy.
K Amer
Lecture
4 years ago
1146 views
42 likes
0 comments
59:32
Bronchoscopy for thoracic surgeons
The idea of this lecture originated from the fact that there is very little teaching material which described bronchoscopy as practiced by the thoracic surgeon. Chest physicians (pulmonologists) perform flexible bronchoscopy on a sedated patient, and they get up-side-down views to that obtained by the surgeons. Bronchoscopy at our department is performed under general anaesthesia, usually in the anaesthetic room just before the operation. We introduce a rigid bronchoscope first, and then a flexible fibre optic 5mm bronchoscope through the rigid scope into the trachea. This arrangement enables precise diagnosis due to excellent vision, with the ability to transform the procedure into a therapeutic session, for example, to take large biopsies, and decide to laser a lesion or to put in a central airway stent. Controlled breathing makes it safer to control significant bleeding during the procedure, and it is understandable that chest physicians shy away from biopsying carcinoid tumours.
The video is divided into 6 chapters. Chapter one deals with the identification of the bronchopulmonary segments and a bit of history about the two systems of nomenclature. It describes in a simplified way the effects of the heart growing in the left chest and the results of fusion, rotation and delayed branching of bronchi. Chapter 2 deals with normal bronchoscopy and anatomy of trachea, main bronchi, and segmental bronchi. Chapter 3 deals with abnormalities of the upper airways and trachea. Chapter 4 deals with abnormalities of the right bronchial tree, and chapter 5 deals with abnormalities of the left bronchial tree. The emphasis is on surgical pathology, assessment of airway for resection and decision-making. The viewer is encouraged to take the test on chapter 6 to bolster his/her knowledge of the anatomy of the airways.

1. Objectives:
a. To identify the bronchopulmonary segments in a logical and easy way to recall.
b. To understand the embryological changes resulting from heart growing into left chest.
c. To state what the operator should look for, what is normal and what is abnormal.
d. To help decision-making at operation and in the perioperative period.

2. For whom is this video made:
a. Consultants and trainees in the specialty of cardiothoracic surgery, including paediatric thoracic surgeons.
b. Thoracic and general anaesthetists who are involved with single lung ventilation.
c. Chest physicians who perform bronchoscopy, to understand views and capabilities of flexible over rigid bronchoscopy, and to have a gist of what goes on the mind of a thoracic surgeon when performing bronchoscopy.
d. Intensivists who might perform bronchoscopy via an endotracheal tube for a ventilated patient in the intensive care unit (ICU).
e. Medical students interested in the detailed anatomy of the central airways.

3. What this video is not intended to do:
a. This is not a compendium of abnormalities and pathologies revealed by bronchoscopy.