Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon's robotic experience.

PURPOSE: In this study, we aim to analyze the learning curve of each step of robotic transabdominal pre-peritoneal inguinal hernia repair (rTAPP) in two surgeons with varying degrees of expertise with the robotic platform but no experience with laparoscopic hernia repair. METHODS: Data on 124 rTAPP cases performed by two surgeons were retrospectively reviewed. Cumulative sum (CUSUM) analysis was applied to visualize the learning curve of rTAPP on operation time of each step of the procedure [the peritoneal flap creation (T1), the completion of the critical view of the myopectineal orifice (T2), the mesh application (T3) and the peritoneal flap closure (T4)]. Each intraoperative and postoperative outcome was compared according to surgeon's experience with the robotic platform and learning phase. The robotic surgeon mentored the surgeon-in-training and was present during all surgeries in his learning period. RESULTS: The surgeon in training with the robotic platform showed a learning phase till the 20th procedure followed by a gradual improvement in performances. The expert surgeon showed a learning phase till the 35th procedure after which a constant decrease of operative time was recorded till the last procedure included. The operative times of each step of the procedures of both surgeons were significantly improved after the learning phase. In the late phase, the surgeon in training could achieve operative times in T2 and T3, which are similar to those of an experienced robotic surgeon with no experience with TAPP before the completion of the learning phase. CONCLUSIONS: In conclusion, the learning phase of rTAPP surgery may vary between 20 and 35 cases, depending on the surgeon's experience in robotic surgery.

Open versus laparoscopic gastrectomy for advanced gastric cancer: a propensity score matching analysis of survival in a western population-on behalf of the Italian Research Group for Gastric Cancer.

BACKGROUND: Oncologic outcomes after laparoscopic gastrectomy for advanced gastric cancer in the West have been poorly investigated. The aim of the present study was to compare survival outcomes in patients undergoing curative-intent laparoscopic and open gastrectomy for advanced gastric cancer in several centres belonging to the Italian Research Group for Gastric Cancer. METHODS: Data of patients operated between 2015 and 2018 were retrospectively analysed. Propensity Score Matching was performed to balance baseline characteristics of patients undergoing laparoscopic and open gastrectomy. The primary endpoint was 3-year overall survival. Secondary endpoints were 3-year disease-free survival and short-term outcomes. Multivariable regression analyses for survival were conducted. RESULTS: Data were retrieved from 20 centres. Of the 717 patients included, 438 patients were correctly matched, 219 per group. The 3-year overall survival was 73.6% and 68.7% in the laparoscopic and open group, respectively (p = 0.40). When compared with open gastrectomy, laparoscopic gastrectomy showed comparable 3-year disease-free survival (62.8%, vs 58.9%, p = 0.40), higher rate of return to intended oncologic treatment (56.9% vs 40.2%, p = 0.001), similar 30-day morbidity/mortality. Prognostic factors for survival were ASA Score ≥ 3, age-adjusted Charlson Comorbidity Index ≥ 5, lymph node ratio ≥ 0.15, p/ypTNM Stage III and return to intended oncologic treatment. CONCLUSIONS: Laparoscopic gastrectomy for advanced gastric cancer offers similar rates of survival when compared to open gastrectomy, with higher rates of return to intended oncologic treatment. ASA score, age-adjusted Charlson Comorbidity Index, lymph node ratio, return to intended oncologic treatment and p/ypTNM Stage, but not surgical approach, are prognostic factors for survival.

Strong impact of sarcopenia as a risk factor of survival in resected gastric cancer patients: first Italian report of a Bicentric study.

Gastric cancer (GC) accounts for 4% of all cancers in Europe. Sarcopenia is a complex syndrome characterized by a loss of muscle mass and function associated with age, often present in neoplastic patients. Recently, several studies have shown a significant association between sarcopenia and poor prognosis in various pathological conditions. The current observational retrospective study investigates the association between sarcopenia and overall survival (OS) and recurrence-free survival (RFS) in patients with GC undergoing up-front surgery with curative intent. Resected GC patients' clinical records and CT images were retrospectively assessed. The preoperative CT calculation of the skeletal muscle index (SMI) at L3 level allowed us to categorize patients as sarcopenic or not. Kaplan-Meyer and univariate and multivariate Cox regression analyses were performed to determine the difference in survival and presence of independent prognostic factors. Fifty-five patients, 28 male and 27 female, out of 298 studied for gastric cancer were enrolled in the current study from two cancer referral centers in Italy. The preoperative CT calculation of the SMI at L3 level allowed us to identify 39 patients with and 16 without sarcopenia. A statistically significant difference between the sarcopenic and non-sarcopenic groups was observed in both OS and RFS (p < 0.023; p < 0.006). Moreover, sarcopenia was strongly correlated to a higher risk of recurrence in univariate and multivariate analysis (p < 0.02). Sarcopenia can be considered a critical risk factor for survival in patients with resectable GC treated with up-front surgery. Identifying sarcopenic patients at the time of diagnosis would direct selection of patients who could benefit from early nutritional and/or physical treatments able to increase their muscle mass and possibly improve the prognosis. More extensive multicenter studies are needed to address this issue.

Preoperative biliary drainage in hilar cholangiocarcinoma: Systematic review and meta-analysis.

BACKGROUND: The role of preoperative biliary drainage (PBD) for hilar cholangiocarcinoma (HCC) remains unclear. The aim of this meta-analysis is to investigate the role of PBD in the treatment of potentially resectable HCC. METHODS: All studies reporting outcomes on patients with PBD vs without PBD were included. A systematic literature search was performed in PubMed, Embase, and the Cochrane Library for studies published between 1980 and 2016. RESULTS: Initial search identified 667 articles. Only 9 studies met the inclusion criteria and were included in this analysis. No significant differences in mortality were observed between the two groups (RR = 0,935; 95% CI = 0,612 to 1429; p = 0,463). Overall morbidity was significantly higher in PBD group (RR = 1266; 95% CI = 1039 to 1543; p = 0,011). No significant differences in transfusion rate, hospital stay, anastomotic leaks, abdominal collections and operative time, were found. Wound infections were significantly higher in PBD group. CONCLUSIONS: PBD seems to be associated with higher postoperative morbidity and increases the risk of wound infections. Further prospective studies are needed to better define the impact of PBD in outcomes after surgery for hilar cholangiocarcinoma.

Lymphatic endothelial cells derived from metastatic and non-metastatic lymph nodes of human colorectal cancer reveal phenotypic differences in culture.

Colorectal cancer is one of the most frequent causes of death in Western countries. Most patients develop metastasis traveling through the lymphatic system, and regional lymph node metastasis is considered a marker for dissemination, increased stage, and worse prognosis. Despite rapid advances in tumor biology, the processes that underpin lymphatic invasion and lymph node metastasis remain poorly understood. The aim of this study was to establish an easy protocol for isolation of pure tumor lymphatic endothelial cells derived from lymph nodes to study differences compared with normal endothelial cells of uninvolved tissue from the same patients. Cells were isolated with very high purity via magnetic cell sorting and express the specific lymphatic markers Prox-1 and Lyve-1. They show differences in expression of adhesion molecules, chemokines, and growth factor secretion, and capability to form capillaries when seeded on basal membrane, thereby, revealing important differences between the two cell type. These cultures may provide a promising platform for the comparative analysis of both cell types at the molecular and biological level and to optimize treatment strategies.

Outcome after surgical resection for duodenal adenocarcinoma in the UK.

BACKGROUND: Factors influencing long-term outcome after surgical resection for duodenal adenocarcinoma are unclear. METHODS: A prospectively created database was reviewed for patients undergoing surgery for duodenal adenocarcinoma in six UK hepatopancreaticobiliary centres from 2000 to 2013. Factors influencing overall survival and disease-free survival (DFS) were identified by regression analysis. RESULTS: Resection with curative intent was performed in 150 (84·3 per cent) of 178 patients. The postoperative morbidity rate for these patients was 40·0 per cent and the in-hospital mortality rate was 3·3 per cent. Patients who underwent resection had a better median survival than those who had a palliative surgical procedure (84 versus 8 months; P < 0·001). The 1-, 3- and 5-year overall survival rates for patients who underwent resection were 83·9, 66·7 and 51·2 per cent respectively. Median DFS was 53 months, and 1- and 3-year DFS rates were 80·8 and 56·5 per cent respectively. Multivariable analysis revealed that node status (hazard ratio 1·73, 95 per cent c.i. 1·07 to 2·79; P = 0·006) and lymphovascular invasion (hazard ratio 3·49, 1·83 to 6·64; P = 0·003) were associated with overall survival. CONCLUSION: Resection of duodenal adenocarcinoma in specialist centres is associated with good long-term survival. Lymphovascular invasion and nodal metastases are independent prognostic indicators.

Video-assisted thoracic surgery (VATS) of the lung: analysis of intraoperative and postoperative complications over 15 years and review of the literature.

BACKGROUND: Video-assisted thoracic surgery (VATS) in the diagnosis and treatment of pulmonary diseases has been used since the early 1990s, yet its impact on intraoperative and postoperative morbidity has not yet been fully evaluated. This report aims to provide a retrospective analysis of the literature and the authors' clinical experience with VATS in pulmonary surgery, with the goal of ascertaining rational criteria that explain operative complications and thus improve outcomes. METHODS: Over a period of 15 years 1,615 VATS procedures were performed in our department, 743 of which involved only the lung. The accesses employed were based on the use of three ports through which a thoracoscope, endoscopic instruments, and an endostapler were inserted; for major pulmonary resections, a utility thoracotomy without rib spreader was added. Resections less than segmentectomy were performed using the endostapler directly on the parenchyma, whereas in the anatomic resections all the hilar structures were isolated and separately sectioned. RESULTS: The procedures performed were as follows: surgical biopsy, 98; wedge resection, 412; segmentectomy, 15; lobectomy, 217; pneumonectomy, 1. Besides the cases in which there were intraoperative complications that could be resolved thoracoscopically, it was necessary to convert to open surgery in 80 patients (10.8%): in 24 (3.3%), for general reasons linked to the technique of VATS itself; in 56 (7.5%), for specific causes correlated to the type of exeresis. The overall postoperative morbidity rate was 8.3% with no deaths. CONCLUSIONS: The analysis of the literature and our experience show that VATS is a reliable approach to the diagnosis and treatment of pulmonary diseases with low complication rate. To further reduce intraoperative and postoperative morbidity, however, it is necessary to select the patients carefully, to adhere strictly to oncological surgical principles, and to adopt a meticulous technique. Although conversion to open surgery represents failure of VATS, it is mandatory when the procedure is not completely safe.

Video-assisted thoracic surgery in the treatment of pleural empyema.

BACKGROUND: The use of video-assisted thoracic surgery (VATS) in the treatment of pleural empyema has been proposed since the early 1990s, but among surgeons, its use varies considerably, and the results are discordant. This report aims to provide a retrospective assessment of the authors' experience and the literature on VATS in an effort to ascertain rational criteria for the use of this technique. METHODS: Over a period of 12 years, a total of 120 cases of pleural empyema were recorded. The patients were assessed with chest x-ray, computed tomography, ultrasound, and thoracentesis. On the basis of clearly defined clinical and radiographic parameters, 38 patients underwent VATS immediately, whereas the remaining 82 were treated initially by means of tube thoracostomy. The latter was found to be sufficient for only 10 patients. Consequently, for the remaining 72 patients, it was decided to proceed also with VATS. RESULTS: The procedure was performed completely by VATS in 101 patients (91.8%), whereas in 9 patients (8.2%) it was necessary to convert to thoracotomy. The postoperative course was uneventful for 98 of the 110 patients (89%), whereas the remaining 12 patients experienced complications, including one case of persistent empyema (0.9%) treated by thoracotomy. The mean chest tube duration was 6 days (range, 3-25 days). The mean postoperative hospital stay was 7.1 days (range, 5-17 days). Of the 80 patients completing a 6-month follow-up evaluation, the results were considered good for 72, moderately good for 8, and less than satisfactory for 2 patients. CONCLUSIONS: In conclusion, the authors consider VATS to be the technique of first choice for the treatment of pleural empyema when the disease is advanced or tube thoracostomy fails. It provides excellent results with a low level of invasiveness and considerably reduces the need for thoracotomy. These results can be achieved with good videothoracoscopic experience and the use of a very precise technique.

Long-term results of video-assisted thoracic surgery lobectomy for stage I non-small cell lung cancer: a single-centre study of 104 cases.

The use of video-assisted thoracic surgery (VATS) for carrying out major pulmonary resections in the treatment of lung cancer is still controversial. In order to contribute to knowledge about the long term results obtained with this technique in the treatment of stage I NSCLC, we present data relating to research in our institute over the past 10 years. From January 1993 to December 2002, 138 patients with peripheral clinical stage I NSCLC were selected to undergo VATS lobectomy. The procedure was based on a mini-thoracotomy without rib spreading, with hilar dissection and separate sectioning of the arteries, veins and bronchi; this was associated with hilar and mediastinal lymph-node sampling. Follow-up consisted of clinical and radiological examination every 6 months in the first 2 years after surgery, then once a year; a CT scan was carried out 1, 3 and 5 years after surgery. The probability of survival was estimated with the Kaplan-Meier method. Surgery by VATS was successfully completed in 122 cases, with a thoracotomy conversion rate of 11.6%. Of these, stage I was confirmed by pathological examination in only 104 cases: there were 56 T1N0 and 48 T2N0. With a mean follow-up of 65 months, the 5-year survival rate was found to be 67+/-10%; in the T1N0 it was 68+/-15%, whereas in the T2N0 it was 67+/-16%. The rate of local or regional recurrence was 4.8% while the systemic recurrence rate was 15.4%. From an appraisal of the study results we consider VATS to be a valid approach for carrying out lobectomy for the treatment of stage I pulmonary carcinoma. The long-term results are comparable to those obtained in open surgery both in terms of survival and the rate of local recurrence. Therefore in selected cases, where there is no increase in surgical risk, VATS may be the preferred approach.

Video-assisted thoracic surgery major pulmonary resections. Present experience.

OBJECTIVE: The purpose of this report is to review our experience of video-assisted thoracic surgery (VATS) major pulmonary resections. METHODS: From January 1993 to December 1999 we proposed VATS, for major pulmonary resections, with these indications: benign lesions and solitary metastases not removable by wedge resection and stage I non-small cell lung cancer (NSCLC). The maximum size of the lesion had to be less than 4 cm. RESULTS: There were 125 patients, 87 men and 38 women with a mean age of 62. We successfully performed VATS procedure in 112 cases (one hamartoma, one tubercoloma, 12 typical carcinoids, 11 metastases and 87 lung cancers), while in another 13 (10.4%) a conversion to open surgery was required. There were 108 lobectomies, three bilobectomies and one pneumonectomy. Out of the first three cases of NSCLC, in all patients mediastinal node sampling or lymphadenectomy was performed. We recorded 13 (11.6%) postoperative complications, one of which required re-operation (bleeding). In the 99 patients without complications, the mean postoperative stay was 5.8 days. In a mean follow-up period of 36 months with patients having lung cancer we achieved a 3-year survival rate of 85+/-9 and 90+/-8% when only the patients in Stage I were considered. CONCLUSIONS: We believe that VATS, in performing pulmonary lobectomy, is a safe and effective approach and it seems to give the same long-term results as open surgery. Now the main problems concern the indications that should be strictly respected and the conversion to thoracotomy which should be undertaken without hesitation when the anatomic or pathologic conditions are not favourable.

Video-assisted thoracic surgery (VATS) lobectomy for typical bronchopulmonary carcinoid tumors.

BACKGROUND: Indications for the use of video-assisted thoracic surgery (VATS) lobectomy are a controversial matter. This study aims to provide a retrospective evaluation of VATS lobectomy in typical bronchopulmonary carcinoids. METHODS: Patient selection criteria for VATS lobectomy were as follows: (a) typical carcinoids with clear diagnosis; (b) centrally located lung tumors not amenable to bronchial resection with bronchoplastic procedures, or tumors located in peripheral lung tissues; (c) no hilar or mediastinal lymph node enlargement; and (d) normal respiratory function. Between January 1995 and December 1999, 12 patients (eight men and four women with a mean age of 57 years) were treated, seven with a peripheral and five with a centrally located tumor. Preoperative examination included chest roentgenograms, computed tomography (CT) of the chest, bronchoscopy, and spirometry; diagnosis was established by direct bronchoscopy in five cases, transbronchial biopsy in two cases, transthoracic biopsy in two cases, and video thoracoscopic wedge resection in three cases. Eleven VATS lobectomies and one VATS bilobectomy were performed. All patients underwent hilar lymphadenectomy and mediastinal sampling. RESULTS: There were no intraoperative complications. The only postoperative complication, hematothorax (8.3%), required VATS reoperation. Mean postoperative hospital stay was 5.33 days. Pathological examination of the resected specimens confirmed that the procedure was radical in all 12 patients and revealed eight T1N0 and four T2N0. At a mean follow-up of 30 months, no signs of recurrence were recorded. CONCLUSION: VATS lobectomy in the treatment of selected typical carcinoids, both central and peripheral, seems to yield favorable results and is therefore preferable to thoracotomy since it is less invasive.

[Video thoracoscopic treatment in pleural empyema]. / Il trattamento videotoracoscopico dell'empiema pleurico.

BACKGROUND: To evaluate the possible role and the effectiveness of videothoracoscopy (VATS) in the treatment of pleural empyema. METHODS: Personal experience on 40 cases of pleural empyema treated by (VATS) during 5 years is reported. The underlying diseases were: pneumonia (32), pneumothorax (3), tuberculosis (2), abdominal diseases (2) and lung cancer (1). Before VATS at least one thoracentesis was performed to evaluate the characteristic of the pleural fluid. RESULTS: Due to complications related to thick pleural adhesions, in one case (2.5%) the procedure was converted to open surgery, while in the remaining 39 cases VATS was able to achieve a complete cleaning of the pleural space with re-expansion of the pulmonary parenchyma. The improvement of the clinical symptoms were observed after a mean period of 3.5 days (range: 1-12 days). Chest tube was removed in a mean period of 4.8 days (range: 3-11 days); five patients had prolonged air leak from 6 to 10 days after surgery. CONCLUSIONS: In conclusion we are of the opinion that VATS has to be considered a very important mean for the treatment of pleural empyema; its use in the fibrinopurulent phase of the disease should give very good results, while in the following phase its indications are controversial.

Prognostic and predictive value of intratumoral microvessels density in operable non-small-cell lung cancer.

Experimental evidence suggests that tumor growth and progression depend on angiogenesis. In a retrospective study we evaluated the relationship between tumor angiogenesis and survival in patients with NSCLC treated with potentially curative surgery between 1992 and 1997. The study population consisted of 76 patients. An anti-CD34 monoclonal antibody was used to measure angiogenesis in tumor samples. Angiogenesis was quantified in terms of microvessel count (MVC): in each sample the three most intense regions of neovascularization were identified under low microscopic power. A x250 field in each of the three areas was then counted and the highest count of the three fields was recorded. Disease free (DFS) and overall survival (OS) during follow up were evaluated. Gender, age, stage, histologic type and KI-67 were the other factors considered for analysis. The median MVC in our series was 41.5. Among the clinicopathologic parameters examined the microvessel count was the only one to show a significant association with disease free survival in univariate analysis (P = 0.04). MVC value is a new indicator of tumor aggressiveness in patients with NSCLC who underwent potentially curative surgery and should be taken into consideration in selecting patients for adjuvant treatment.

Diagnostic role of videothoracoscopy in mediastinal diseases.

OBJECTIVE: In order to assess the role of videothoracoscopy in the diagnosis of mediastinal diseases, we report a retrospective analysis of 52 cases of mediastinal biopsy performed with this technique. METHODS: Between January 1992 and December 1996 52 patients (39 men and 13 women, mean age 53 +/- 29 years) with mediastinal lesions were referred to our department for videothoracoscopic biopsy. There were eight lesions in the anterior mediastinum, while the remaining 44 were in the middle (25 right and 19 left). The adenopathies were solitary or located in positions not within reach of the mediastinoscope, or combined with pulmonary nodules or diffuse pulmonary diseases. RESULTS: The procedure was performed from the right side in 30 cases and from the left side in 22. In nine cases the complete excision of the mass was achieved. In the eight patients with pulmonary disease a wedge resection was carried out at the same time. Diagnosis was achieved in all cases of mediastinal and lung disease (100%). No conversion to open thoracotomy and no intraoperative complications occurred. The mean hospital stay after surgery was 2.3 +/- 1.3 days in the 49 (94.2%) patients with no complications. The postoperative complications consisted of one case of fatal pulmonary embolism and two cases of prolonged air leak. conclusion: This analysis shows that videothoracoscopy is an effective and reliable method of obtaining a diagnosis of solitary unilateral mediastinal lesions or of adenopathies not within reach of the mediastinoscope. In some cases it also allows the complete excision of the mass. If a procedure on the lung such as a wedge resection is needed, it can be performed at the same time. Since this is a strictly unilateral procedure, it cannot be used in routine preoperative lung cancer staging.

[Surgical treatment of chronic pericardial effusions. Personal experience]. / Il trattamento chirurgico dei versamenti cronici del pericardio. Esperienza personale.

The authors report their experience about 15 patients surgically treated for chronic large pericardial effusion; in 12 cases the etiology was malignant neoplasm, while in the other 3 cases was inflammatory disease. In 4 patients a simple subxiphoid pericardial drainage was carried out, while in the other cases a pericardial window was performed. These cases were managed using an anterior left thoracotomy in 8 patients and a videothoracoscopy in 3. The authors conclude that pericardial window with videothoracoscopic approach is the preferable procedure, but it cannot be used in every case because a lot of patients have seriously compromised conditions and the use of this technique can be hazardous.

Role of videoendoscopy in pulmonary surgery: present experience.

Videothoracoscopic techniques were utilized in managing 88 consecutive patients. The series was composed of 36 patients with pneumothorax, 44 cases of single and 9 of multiple pulmonary nodules and 1 patient with diffuse lung disease. In 14 cases (15.9%) conversion to open thoracotomy was necessary while in the remaining 74 patients the procedure (30 blebectomies, 2 bullectomies, 37 wedge resections, 6 lobectomies and one multiple biopsies) were carried out as planned. In each lobectomy and in six wedge resections an accessory small incision was necessary; we consider only this video-assisted thoracic surgery (VATS). Benign disease, aside from the blebs and bullae, was found in 12 cases of solitary pulmonary nodules and in 1 case of multiple lesions, while malignant lesions were detected in 31 patients. Primary carcinoma was diagnosed in nine cases after a wedge resection had been performed on a suspicious solitary nodule. In two of these wedge resection had to suffice because of poor lung function, while in the remaining seven cases, a lobectomy was carried out through an open thoracotomy in two patients, and in five cases VATS was attempted successfully in four, while in one case a formal thoracotomy was necessary due to bleeding. Solitary metastases were found in 14 patients and were managed by 12 wedge resections and 2 lobectomies. Seventy-one patients (97.3%) had an uneventful postoperative course while 2 (2.7%) had only minor complications. No recurrences were observed, however follow-up is limited. Videothoracoscopy techniques are very useful and are good alternatives to conventional thoracotomy in managing cases of pneumothorax, benign pulmonary lesions and in taking biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Video-assisted lower pulmonary lobectomy]. / La lobectomia polmonare inferiore video-assistita.

The authors present 2 cases of pulmonary lower lobectomy (right and left) using video-assisted modality. The I patient had a stage I NSCLC and the II had a metastasis from rectal carcinoma. The operation was performed using the modern videoendoscopic means introduced into the thoracic cavity thorough three ports and an anterior 4 cm mini-thoracotomy. The patients had an uneventful postoperative course and no pain or trouble breathing were observed. In conclusion the authors are of the opinion that performing lower pulmonary lobectomy, video-assisted technique is feasible and reliable; in very selected cases it should become the modality of choice.

[Treatment of hepatic trauma. Our experience with 14 surgically treated cases]. / Trattamento del trauma epatico. Nostra esperienza su 14 casi operati.

The authors report their experience of 14 cases of hepatic trauma that underwent surgical treatment. During the period 1987-1990, 42 patients were admitted with diagnosis of hepatic injuries to the surgical department of Ravenna Hospital. 28 of the 42 patients were subjected to repeated abdominal echography and didn't undergo surgical treatment. The authors consider the importance of the abdominal echography whether of the surgical treatment or nonoperative management. Prognosis is always serious, and it is influenced by three factors: the kind of trauma, the concomitant lesions and the general conditions of the patient. The authors, in conclusion, report the per cent of survive and of complications that they have found.

[Percutaneous needle aspiration biopsy in intrathoracic lesions]. / Agoaspirato percutaneo nelle diagnosi delle lesioni intratoraciche.

The authors report their experience of transthoracic needle biopsy of the lung based on 68 consecutive cases from 1984 to 1990. In 55 cases significant data has been found: in 44 cases the diagnosis was exact, instead in other 11 cases it was only indicative. The overall complications were 11.7% and in particular were as follow: pneumothorax in 5 cases, hemoptysis in 2 cases and a temporary Horner syndrome in one case. The authors conclude by confirming the utility of transthoracic needle biopsy of intrathoracic tumors in which there is not other way to obtain a diagnosis. This technique is reliable and its complications can be disregarded.