Thoracic surgery in Australia.
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ABSTRACT:
SUBMITTER: Wright GM
PROVIDER: S-EPMC8902099 | biostudies-literature | 2022 Feb
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC8828507 | biostudies-literature
Project description:BackgroundCytokines play a crucial role in the inflammatory response and are essential modulators of injury repair mechanisms. While minimally invasive operations have been shown to induce lower levels of cytokines compared to open thoracotomy, the inflammatory cytokine profile difference between video-assisted (VATS) and robotic-assisted thoracic surgery (RATS) techniques has yet to be elucidated.MethodsIn this prospective observational study of 45 patients undergoing RATS (n=30) or VATS (n=15) lung resection for malignancy, plasma levels of interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, vascular endothelial growth factor (VEGF), interferon (IFN)-γ, tumor necrosis factor (TNF)-α, monocyte chemo-attractant protein (MCP)-1, and endothelial growth factor (EGF) were measured before and after surgery via immunoassay.ResultsLevels of IL-6 and MCP-1 were significantly higher in patients undergoing VATS than in patients undergoing RATS (P<0.001 and P=0.005, respectively) 2 hours following surgery. MCP-1 levels were also found to be significantly higher in the VATS group (P<0.001) 24 hours following surgery. IL-1α, IL-1β, IL-2, IL-4, IL-8, IL-10, IFN-γ, TNF-α, and EGF levels were not significantly different at any time-point comparing VATS to RATS.ConclusionsThe VATS approach is associated with a more robust pro-inflammatory cytokine response through the upregulation of MCP-1 and IL-6 when compared to the RATS approach in patients undergoing anatomic lung resection. Further studies are necessary to validate the clinical significance of this finding.
| S-EPMC9264093 | biostudies-literature
Project description: Not available
| S-EPMC10326782 | biostudies-literature
Project description:Estonia, a small Northern European country with the population of 1.3 million, has two centres of thoracic surgery, both established in 1960s. One is in the capital Tallinn, and another in the university town Tartu. Both departments cover the full spectrum of thoracic surgery, apart from oesophageal cancer surgery, yet including paediatric operations and chest trauma management. However, the focus is on lung cancer surgery. Currently, the proportion of lung cancer cases treated surgically is 20% in Estonia. Between 2000 and 2015 the proportion of lobectomies increased from 53% to 76%, while pneumonectomies decreased from 28% to 8%. Although the absolute number of lung cancer operations in Estonia is small, upon need complex and extended resections are performed. In the last decades a considerable survival gain of lung cancer patients has been observed. Minimally invasive surgery is widely used since its implementation in 1995, with the list of indications constantly evolving. In 2005, first video-assisted thoracoscopic (VATS) thymectomy and lobectomy were performed. VATS as surgical access in lung cancer operations exceeded thoracotomy in 2015 and is currently considered in all cases. In 2018, the first uniportal VATS sleeve-lobectomy was performed. The lung transplant program is functioning together with other solid organ transplant programs only at the Tartu University Hospital. Up to now, 33 lung transplantations have been performed, including lobar transplantations, a paediatric case, a few urgent cases for patients on extracorporeal membrane oxygenation (ECMO), and two re-transplantations. General thoracic surgery is a separate monospeciality in Estonia with an independent 5-year residency program, which is arranged by the Medical Faculty of University of Tartu. In last years, thoracic surgery related research in Estonia has mainly focused on lung cancer detection and management. Currently, a national lung cancer screening program feasibility study is being led by thoracic surgeons.
| S-EPMC9186225 | biostudies-literature
Project description: Not available
| S-EPMC9562510 | biostudies-literature
Project description:Until recently, thoracic surgery in France was associated with vascular or cardiac surgery. It is now increasingly performed as a specific activity. Training of a thoracic surgeon has a common part with cardiovascular surgery during a 6-year curriculum including theory and practical practice acquired both by simulation and clinical fellowship. There are 343 board-certified surgeons performing thoracic surgery in 147 authorized centers. To be authorized to perform thoracic surgery, these centers must have at least 2 qualified surgeons and perform a minimum of 40 procedures per year for thoracic cancer. The discussion of the cases in a multidisciplinary tumor board (MDTB), validated by a written conclusion, is also mandatory and is a prerequisite for operating on patient for any cancer. All thoracic surgery procedures are recorded in a national database, Epithor. This database gives a precise idea not only of the activity but also of operative data, morbidity, mortality and follow-up. In 2023, participation to Epithor database will be a prerequisite for the certification of thoracic surgeons. Major changes in diagnostic and therapeutic options, development and innovations in video-assisted and robotically-assisted surgery, forthcoming transbronchial approaches will more likely lead to reorganize thoracic surgery with specialized and expert multidisciplinary boards as well as a concentration in high volume centers.
| S-EPMC9344406 | biostudies-literature
Project description:Thoracic surgery in Palestine ran across a significant shift in the past couple of years, moving from performing all surgeries by open thoracotomy incision to the current rate of more than two-thirds of surgeries being conducted using Uniportal video-assisted thoracic surgery (VATS). Thoracic surgeons most commonly deal with lung cancer, followed by chest trauma, inflammatory or infectious diseases, and congenital malformations of the chest. One of the most prominent strengths that Palestinian thoracic surgeons have is their extensive experience in managing trauma and hydatid cyst patients. While the limited number of thoracic surgeons, the complex referral process between governmental and private hospitals, and the late presentation of lung cancer patients are considered the specialty's weaknesses. Despite the challenges that thoracic surgeons face, they aim to overcome them by establishing lung cancer screening programs and enhancing the role of the primary healthcare system in order to achieve better outcomes in early diagnosed patients. Moreover, thoracic surgeons are relentlessly determined to take part in global research and publish their most notable contributions to share their experiences and prove that they can make a real change. Finally, the authors emphasize establishing a well-constructed thoracic surgery unit, which also includes a residency training program to ensure self-sufficiency in the future by having national graduates who will be the leading providers and researchers.
| S-EPMC9186221 | biostudies-literature
Project description:In the era of modernized medicine, thoracic surgery has been focusing on achieving minimally invasive surgery and providing a one-stop solution in treating thoracic diseases. Particularly in the Asia population, where patients are keen to have smaller wound and shorter hospital stay, thoracic surgery in Hong Kong has evolved from the traditional open thoracotomy approach to video-assisted thoracoscopic surgery (VATS). In our institution, uniportal VATS for major lung resection was developed in 2012. While uniportal VATS has brought advantages into managing thoracic pathologies, it also brought challenges like instrument fencing during manipulation and suboptimal visualization angle. To improve the procedure and its outcomes, novel techniques and equipment have been developed, for example, double-hinged instruments, robotic assisted technology and magnetic anchored and guided endoscopes (MAGS). With advanced medical imaging nowadays, management of small lung nodules or ground glass opacity (GGO) is in higher demand than ever before. Our hybrid operating room (HOR) can incorporate instant and real-time imaging in lesion localization, and provide treatment via VATS or electromagnetic navigated bronchoscopic (ENB) ablation in a one-stop manner. This paper will review the literature related to the historical development and clinical outcomes of thoracic surgery in Hong Kong and discuss the future perspective of ongoing development.
| S-EPMC9442542 | biostudies-literature
Project description:The purpose of this article, part of the Thoracic Surgery Worldwide series, is to provide a descriptive review of how thoracic surgery is organized in the Netherlands. General information is provided on the Dutch healthcare system, as well as on how Dutch thoracic surgeons are organized and trained. Additionally, this study provides information on our national quality surveillance system, an overview of the most common thoracic surgeries performed in our country, and details of academic research conducted by Dutch medical specialists. Furthermore, we discuss current challenges and future perspectives. In the Netherlands general thoracic surgical procedures are performed by approximately 110 general thoracic surgeons and 25 of the 135 cardiothoracic surgeons. Dutch thoracic surgeons provide minimally invasive lung surgery, chest wall surgery, thymic and mediastinal surgery, and surgical diagnosis and treatment of pleural disorders. Some recently published data on hospital mortality and postoperative adverse events of thoracic surgeries are reported. Furthermore, the structure of the thoracic surgical education and training program is discussed, highlighting the particular structure of two educational programs for thoracic surgery via a general thoracic and cardiothoracic surgery program. To assure high-quality surgical care, the Netherlands has a well-structured national quality surveillance system, involving frequent site visits and mandatory participation in the national lung cancer surgery registry for all hospitals. In terms of academic research, the Netherlands ranked 14th worldwide on number of clinical trials conducted across all medical disciplines in 2021. Furthermore, several thoracic-related (inter-)national multicenter randomized trials which are currently performed and initiated by Dutch hospital research groups are mentioned. Finally, future challenges and advances of Dutch thoracic surgery are addressed, including the implementation of lung cancer screening, imbalanced labor market, and centralization of care.
| S-EPMC9641325 | biostudies-literature
Project description:Intraoperative fluorescence imaging (IFI) can improve real-time identification of cancer cells during an operation. Phase I clinical trials in thoracic surgery have demonstrated that IFI with second window indocyanine green (TumorGlow® ) can identify subcentimeter pulmonary nodules, anterior mediastinal masses, and mesothelioma, while the use of a folate receptor-targeted near-infrared agent, OTL38, can improve the specificity for diagnosing tumors with folate receptor expression. Here, we review the existing preclinical and clinical data on IFI in thoracic surgery.
| S-EPMC6146026 | biostudies-literature