Acute myocardial infarction as presenting symptom of thymoma with compression on a coronary stent.

We report the clinical case of a patient with acute myocardial infarction due to coronary stent compression as first manifestation of a large thymoma. The patient underwent a coronarography and thrombus aspiration + plain old balloon angioplasty restoring the stent patency. The mass resection was performed through left robotic-assisted thoracic surgery (RATS), resulting in a type A thymoma pT1a, IIb Masaoka-Koga.

Accessory V during thoracoscopic middle lobectomy: "an uncomfortable presence".

The identification of the accessory vein draining the superior segment of the right lower lobe (accessory V), during the posterior mediastinal lymph node dissection, can help avoid operative complications.

Elective surgery treatment in patient living in rural area with history of recurrent primary spontaneous pneumothorax: A procedure to avoid in absence of pneumothorax. A case report.

Introduction: Pneumothorax is defined as accumulation of air in the pleural space with secondary lung collapse resulting in dyspnea or chest pain. Currently the optimal management of spontaneous pneumothorax has been standardized, but the question of elective surgery treatment remains unresolved in patients living in rural area with history of recurrent Primary spontaneous pneumothorax [PSP].

Presentation Of Case: A 41 years-old white man living in rural area, with a history of recurrent right spontaneous pneumothorax (three subsequent episodes) treated by positioning of chest tube, was admitted to our unit.

Conversion to thoracotomy during VATS segmentectomy for treatment of symptomatic endobronchial hamartoma.

Introduction: Most hamartomas are located peripherally in the lung parenchyma and are rarely identified as an endobronchial lesion. Clinically patients with an endobronchial hamartoma are often symptomatic and may present with various symptoms including: fever, wheezing, hemoptysis and obstructive pneumonia.

Case Presentation: A 68-year-old man presented with complaints of fever and cough for 1 month.

Three-dimensional (3D) Printed Model to Plan the Endoscopic Treatment of Upper Airway Stenosis.

Background: Endoscopic management of tracheal stenosis may be challenging, especially in the case of complex stenosis placed near the vocal folds, and needing stent placement. Herein, we evaluated the utility of the three-dimensional (3D) airway model for procedural planning in a consecutive series of patients with complex airway stenosis and scheduled for endoscopic treatment.

Methods: This strategy was applied to 7 consecutive patients with tracheal stenosis unfit for surgery.

Morgagni hernia repair in adult obese patient by hybrid robotic thoracic surgery.

Morgagni hernia is a relatively uncommon congenital diaphragmatic hernia in which abdominal contents protrude into the chest through the foramen of Morgagni. It usually occurs on the right side of the chest but may occur on the left side or in the midline. In adults, it commonly presents with non-specific symptoms such as dyspnea, cough, gastroesophageal reflux disease and other.

Exogenous Lipoid Pneumonia due to Chronic Inhalation of Oily Product Used as a Lubricant of Tracheotomy Cannula.

Exogenous lipoid pneumonia (ELP) is caused by the inhalation of vaporized oily products. Long-term exposure can result in chronic disease, whereas acute form usually results from massive aspiration of fatty substances. It has an incidence of 1.

Hybrid robotic thoracic surgery for excision of large mediastinal masses.

Between April 2016 and October 2017, we retrospectively reviewed all patients undergoing excision of large mediastinal masses using a hybrid robotic thoracic approach at the Unit of Thoracic Surgery of Monaldi Hospital in Naples. The inclusion criteria for this approach were: evident unilateral predominance of the mass; absence of invasion to surrounding structures. Planned conversion to sternotomy was necessary in one patient for tenacious adhesions between the mediastinal goiter and the left innominate vein.

Antero mediastinal retrosternal goiter: surgical excision by combined cervical and hybrid robot-assisted approach.

Most intrathoracic goiters are located in the anterior mediastinum. Surgical resection is usually recommended in case of morbidity associated with the goiter's mass effect or for suspicion of malignancy difficult to diagnose without resection. Intrathoracic goiters are usually resected through a cervical approach, with sternotomy needed in selected cases.

Reasons for conversion during VATS lobectomy: what happens with increased experience.

Although controlled studies have demonstrated the benefits of a minimally invasive approach for pulmonary lobectomy over thoracotomy, reports have also documented that significant complications can occur during thoracoscopic lobectomy and sometimes require planned or emergent conversion to open surgery. Several authors have identified and reported causes and implications of intraoperative conversion to thoracotomy using different types of classification. The aim of this single centre retrospective review is to evaluate how the reasons for conversion change with increased experience, dividing patients who were converted to thoracotomy during video-assisted thoracic surgery (VATS) lobectomy, between 2011 and 2017, in two groups: those treated during learning curve (LC group) and those treated after learning curve (ALC group).

Hemorrhagic complication during robotic surgery in patient with thymomatous myasthenia gravis.

The advantages of thymectomy as part of the treatment of myasthenia gravis has been demonstrated repeatedly in the literature. Both single-institution and multi-institution trials have shown robotic thymectomy to be safe, feasible and associated with better early clinical outcomes than the trans-sternal approach. Most reports have also documented the superiority of robotic technology in the dissection of the superior mediastinum over conventional thoracoscopy, thanks to instruments with more degrees of movement and freedom.

Robotic-assisted thoracoscopic surgery thymectomy.

In recent decades, mediastinal surgery has undergone radical innovations. In fact, introduction of minimally invasive methods, such as video-assisted thoracoscopic surgery (VATS), showed several clinical benefits over median sternotomy. Recently the introduction of robotic-assisted thoracoscopic surgery (RATS) has added more technological advantages in mediastinal dissection such as 3-dimensional (3D) vision and multi-articulated instruments.

Comparison of plethysmographic and helium dilution lung volumes in patients with a giant emphysematous bulla as selection criteria for endobronchial valve implant.

Objectives: To assess whether the difference in lung volume measured with plethysmography and with the helium dilution technique could differentiate an open from a closed bulla in patients with a giant emphysematous bulla and could be used as a selection criterion for the positioning of an endobronchial valve.

Methods: We reviewed the data of 27 consecutive patients with a giant emphysematous bulla undergoing treatment with an endobronchial valve. In addition to standard functional and radiological examinations, total lung capacity and residual volume were measured with the plethysmographic and helium dilution technique.

Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication.

Objective: The aim of the present study is to show the predictive value of the preoperative resting pressure of the lower esophageal sphincter (LES) correlated with the type of fundoplication (Nissen or Dor) after Heller myotomy in our series.

Materials And Methods: From January 1998 to June 2010, 88 patients affected by esophageal achalasia underwent surgery at our unit. However, our study focused on a sample of 36 patients, because many data were lost or was never recorded.

The Post-Surgical Long-Term Behaviour of Lung Carcinoid Tumours.

Here, we report a retrospective evaluation of long-term behaviour of lung carcinoids after surgery. A total of 23 patients (17 with typical pulmonary carcinoids and 6 with atypical pulmonary carcinoids) were enrolled in our hospital from April 1994 to July 2009. All patients underwent intervention at the Unit of Surgery and then were followed at the Unit of Oncology.

Interlobar fixation using TachoSil(®): a novel technique.

Background: We evaluated the use of TachoSil(®) for anchoring middle lobe to lower lobe after upper right lobectomy.

Methods: The fixation of middle lobe to lower lobe was required in 39/213 consecutive upper lobectomies. In 19/39 (49%) cases, it was performed with suturing and/or stapler (standard group) and in 20 cases (TachoSil group) with Tachosil(®) alone.

Fundoplication after heller myotomy: a retrospective comparison between nissen and dor.

Objective: A retrospective comparison between Nissen and Dor fundoplication after laparoscopic Heller myotomy for achalasia.

Materials And Methods: From 1998 to 2004 a first group of 48 patients underwent Heller myotomy and Nissen fundoplication for idiopathic achalasia (H+N group). From 2004 to 2010 a second group of 40 patients underwent Heller myotomy followed by Dor fundoplication (H+D group).

Hyperthermia in the treatment of post-actinic osteosarcomas: our anecdotal experience.

Irradiation-induced sarcomas are a late sequelae of irradiation therapy. Most sarcomas have been reported to occur after exposure to a radiation dose of 55 Gys and above, with a dose ranging from 16 Gys to 112 Gys. These tumours are very aggressive and an early detection is needed for a timely intervention.

Fibrosing mediastinitis as a cause of right claudication.

Fibrosing mediastinitis is a rare benign disorder caused by proliferation of acellular collagen and dense paucicellular fibrous tissue within the mediastinum. Its precise cause, pathogenesis and links to infectious (such as histoplasmosis or tuberculosis) and non-infectious (such as sclerosing cholangitis) diseases remain speculative. Affected patients present signs and symptoms related to obstruction of mediastinal hollow organs, such as large vessels, esophagus and airways.

Giant esophageal lipoma.

A case of a giant esophageal pedunculated lipoma diagnosed in a 67-year-old male patient with recent onset of dysphagia is reported. Following the initial endoscopic and radiologic evaluation, the diagnosis was suspected by endo-ultrasonography and confirmed by histopathology. The treatment consisted of an esophagotomy with submucosal resection, through a left sided cervical incision.

Ectopic hepatic tissue misdiagnosed as a tumor of lung.

The ectopic or accessory liver lobe is an uncommon congenital anatomic abnormality. It is considered to be the outcome of an abnormal development of liver tissue during embryologic period. In some cases, it may be secondary to a trauma or a surgical operation.