Prevention of intraoperative bleeding during thoracoscopic left lower lobectomy; an unnecessary occlusion of pulmonary artery and vein.

Complicated hilar anatomy may be technically challenging for thoracic surgeons, especially during video-assisted thoracic surgery lobectomy. In such instances, to prevent hemorrhagic complications and conversion to open thoracotomy, several methods of proximal and distal vascular control have been proposed. Here, we present a technique of unnecessary occlusion of the main pulmonary artery and preserved pulmonary vein during a challenging thoracoscopic left lower lobectomy in patient with lung cancer and interlobar lymphadenopathy.

Circumferential esophageal leiomyoma: Management by combined robotic surgery and intraoperative endoscopy.

Leiomyoma is the most common benign tumor of the esophagus. Open thoracotomy, the traditional approach adopted for the enucleation of the esophageal leiomyoma, over the years, has been gradually replaced by video-assisted thoracoscopic surgery. However, this minimally invasive approach has limitations, such as two-dimensional vision and reduced range of motion, which have recently been overcome by technical advantages of robot-assisted surgery.

Comments on "The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient".

Dear Editor, We have read with interest the case reported by Rotolo et al. (published in February 2023) concerning the surgical management of tracheoesophageal fistula in a COVID-19 patient treated with prolonged mechanical ventilation for severe respiratory failure..

Transbronchial needle aspiration in severe cardiac failure patient: 'The old bull knows best'.

Conventional transbronchial needle aspiration (cTBNA) remains a basic technique that must be part of the bronchoscopists expertise. In cases where EBUS is not available, cTBNA must be kept in mind: 'the old bull knows best'.

Persistent alveolar air leak following pulmonary lobectomy: an old problem in a modern era.

Persistent alveolar air leak (PAAL) after major lung resection remains a common complication in thoracic surgery. The aim of this study was to identify a subset of patients with high risk of developing PAAL after pulmonary lobectomy. Another objective was to evaluate the influence of PAAL on postoperative complications and length of hospital stay.

Post-Intubation Tracheoesophageal Fistula: Surgical Management by Complete Cervical Tracheal Transection.

We report successful surgical management of post-intubation tracheoesophageal fistula (TEF) in an adult patient requiring long-term mechanical ventilation. A complete tracheal transection without tracheal resection, via an anterior cervical approach, followed by direct closure of tracheal and esophageal defect, and interposition of muscle flap between the suture lines and tracheal reconstruction was performed. In selected cases, this surgical procedure may be a viable alternative to traditional techniques used to treat post-intubation TEF via the anterior or lateral cervical approach.

Alectinib rescue therapy in advanced ALK rearranged lung adenocarcinoma: a case report.

Alectinib is a highly selective tyrosine kinase inhibitor of anaplastic lymphoma kinase (ALK) that is approved as first-line treatment in adult patients with ALK-positive non-small cell lung cancer (NSCLC) and as second-line in patients previously treated with crizotinib, and has been shown in the literature to significantly prolong progression-free survival compared to chemotherapy in patients with advanced non-small cell lung cancer. The authors describe a clinical case of a 24-year-old woman with malignant massive pleural effusion caused by ALK rearranged pulmonary adenocarcinoma with pleural and pericardial metastasis, in which, despite a dramatic clinical debut, the correct and timely management of the diagnostic and therapeutic path allowed for extraordinary therapeutic success.

Unusual Periaortic Mediastinal Recurrence of Pulmonary Adenocarcinoma: When Making Diagnosis Is Really Necessary.

We report an unusual mediastinal recurrence along descending thoracic aorta during oncologic follow-up in a 47-year-old female smoker issued by lung adenocarcinoma with a history of left lower lobectomy and lingulectomy en bloc followed by adjuvant chemotherapy for stage III A-N2. Regional recurrence occurring along the staple line was suspected and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) combined to PET/CT allowed to reach definitive tissue diagnosis. High focal hypermetabolic activity on PET/CT at the site of suspect recurrence was necessary to check the lesion sampling by EBUS-TBNA.

Anomalous segmental pulmonary vein: additional V6 behind the bronchus intermedius draining into the superior pulmonary vein.

Anatomical variations of pulmonary venous drainage have been widely described in the literature in order to perform safe thoracic surgical procedures. We report a case of anomalous vein from the superior segment of the right lower lobe running in the posterior mediastinum and draining into the superior pulmonary vein. As the patient showed a usual right inferior pulmonary vein, formed by the union of the superior segment right lower lobe vein (V6) and the common basal vein joining the left atrium, the uncommon segmental pulmonary vein described was named: additional V6.

Different Therapeutic Strategies in 2 Young Patients with Advanced ALK-Rearranged Lung Adenocarcinoma: "The Light at the End of the Tunnel".

Malignant pleural effusion represents a prognostic negative factor on survival conferring stage IV disease. The median of survival is 5 months and a 5-year survival of about 3%. We describe the therapeutic success obtained from different strategies in anaplastic lymphoma kinase (ALK) inhibitors in 2 young women showing malignant pleural effusion secondary to advanced ALK-rearranged lung adenocarcinoma.

How to avoid "en masse" lobectomy using VATS technique in presence of hilar fibrosis.

Perivascular fibrosis is technically one of the most challenging issue to manage during thoracoscopic lobectomy and it is associated with increased risk of hemorrhagic injury. Here we report a case of thoracoscopic right lower lobectomy performed with individual dissection of segmental arteries due to dense adventitial fibrosis around the right lower lobe pulmonary artery. This approach may be considered as an alternative to the so-called "en masse" lobectomy and a way to avoid conversion to thoracotomy.

Emergency rigid bronchoscopy in two lower social class patients with mirror like complete pulmonary malignant atelectasis.

Several factors as cultural factors and social class other than biological and genetic factor can affect symptom perception in patients with malignant airway obstruction. Poor perception of dyspnoea can result in the delayed seeking of medical care so increase access to intensive care due to impeding respiratory failure. In patients issued from malignant airway obstruction, therapeutic bronchoscopy procedure can not affect the endotracheal extubation although immediate airway patency can be obtained.

Variations in the branching patterns of pulmonary artery during thoracoscopic pulmonary resection.

Purpose: The knowledge of variations in the branching patterns of pulmonary artery may have important clinical implications in the field of thoracic surgery.

Methods: At the Department of Thoracic Surgery of Monaldi Hospital in Naples, between January 2017 and December 2019, 569 anatomic pulmonary resections via video-assisted thoracic surgery, including lobectomy and segmentectomy, were performed.

Results: Among the 569 thoracoscopic pulmonary resections, 24 variations in the branching patterns of pulmonary artery were identified and documented.

Postoperative Bronchopleural Fistula: A Conservative Way of Treatment in Selected Cases.

Background:  Postoperative bronchopleural fistula represents a challenging issue for thoracic surgeons. The treatment options reported include bronchoscopic or surgical procedures but the method yielding the best results remains unclear.

Methods:  In our thoracic surgery department, between January 2011 and June 2020, 11 patients treated conservatively for early bronchopleural fistula after lobectomy or bilobectomy were reviewed.

Uncommon anomalies of the left pulmonary artery during VATS lobectomy for lung cancer.

The key to avoid intraoperative complications due to failure in the preoperative detection of pulmonary vascular anomalies is to perform a careful hilar dissection.

Left pulmonary artery pseudoaneurysm secondary to post-operative lung abscess.

A prompt diagnosis is mandatory to avoid fatal complications in case of pulmonary artery pseudoaneurysm.