Evaluation of electromagnetic navigational bronchoscopic biopsy of lung lesions performed by a thoracic surgical service.

BACKGROUND: With the increasing use of computed tomography scans for lung cancer screening and surveillance of other cancers, thoracic surgeons are being referred patients with lung lesions for biopsies. Electromagnetic navigational bronchoscopy-guided lung biopsy is a relatively new technique for bronchoscopic biopsy. Our objective was to evaluate the diagnostic yields and safety of electromagnetic navigational bronchoscopy-guided lung biopsy. METHODS: We conducted a retrospective review of patients who underwent an electromagnetic navigational bronchoscopy biopsy, performed by a thoracic surgical service, and evaluated its safety and diagnostic accuracy. RESULTS: In total, 110 patients (men 46, women 64) underwent electromagnetic navigational bronchoscopy sampling of pulmonary lesions (n = 121; median size 27 mm; interquartile range 17-37 mm). There was no procedure-related mortality. Pneumothorax requiring pigtail drainage occurred in 4 patients (3.5%). Ninety-three (76.9%) of the lesions were malignant. Eighty-seven (71.9%) of the 121 lesions had an accurate diagnosis. Accuracy increased with increased lesion size (P = .0578) with a yield of 50% for lesions <2 cm, increasing to 81% for lesions ≥2 cm. The lesions that demonstrated a positive "bronchus sign" had a yield of 87% (45/52) compared with 61% (42/69) in lesions with a negative "bronchus sign" (P = .0359). CONCLUSION: Thoracic surgeons can perform electromagnetic navigational bronchoscopy safely, with minimal morbidity and with good diagnostic yields. Accuracy increases with the presence of a bronchus sign and increasing lesion size. Patients with larger tumors and the bronchus sign may be candidates for this approach to biopsy. Further work is required to define the role of electromagnetic navigational bronchoscopy in the diagnosis of pulmonary lesions.

Technique of robotic esophagectomy.

Robotic surgery continues to grow in thoracic surgery, and currently plays an evolving role in esophagectomy. Robotic assisted minimally invasive esophagectomy (RAMIE) has continued to expand, with many institutions adapting the technique. As the overall experience continues to grow, new data is emerging in its support. We present our approach to this operation.

Patient reported outcomes (PROs) after minimally invasive and open esophagectomy.

Esophagectomy for esophageal malignancies remains an operation with significant potential morbidity and mortality. However, surgical outcomes continue to improve over time and focus has shifted toward not just good outcomes, but quality of life post operatively. Patient reported outcomes (PROs) focus of quality of life measures via validated patient surveys has increasingly become a significant focus. While PROs do have their limitations, they represent a glimpse into the symptomatology, quality of life, and well-being of a patient undergoing a procedure with inherent morbidity. Working to improve outcomes from the perspective of the patient is not a new concept, but has becoming increasingly relevant as surgical quality for all procedures improves. The optimal approach to esophagectomy is controversial. Minimally invasive approaches attempt to avoid laparotomy and thoracotomy with the thought of improving post-operative quality of life by mitigating complications related to those open surgical approaches. The data in favor of laparoscopy and thoracoscopy is quite strong and multiple randomized controlled trials exist in this realm supporting minimally invasive approaches with regards to quality of life outcomes and more rapid return to patient's preoperative baseline. The data in favor of a robotic approach for esophagectomy is not quite as robust, but more studies show that these approaches mirror the benefits of the laparoscopic and thoracoscopic approaches without robotic assistance.

Open, Minimally Invasive, and Robotic Approaches for Esophagectomy: What Is the Approach Algorithm?

Esophageal cancer requires a multimodality treatment approach, with surgical resection a key component in many cases. When it comes to esophagectomy, several approaches and techniques exist, including transhiatal versus transthoracic and open versus minimally invasive. Each approach has its associated risks and advantages. When determining the optimal approach and technique, several variables need to be considered. The key variables include patient and tumor characteristics, as well as surgeon comfort and experience with each approach. Regardless of the approach, the goal should remain the same, that is, performing a safe operation without compromise of oncologic principles.

Management of Recurrent Paraesophageal Hernia.

Recurrent symptomatic paraesophageal hernias (PEHs) can lead to significant morbidity if untreated. Surgical treatment of recurrent PEH can pose a great challenge. Several different surgical options are available and need to be considered on an individual basis. Before embarking on the repair of a recurrent hernia, a thorough work-up needs to be completed. Although recurrent PEHs have traditionally been repaired through an open approach, a minimally invasive approach can be performed by surgeons with extensive experience in minimally invasive esophageal surgery. Repair of recurrent PEH provides excellent patient satisfaction and symptoms resolution. Routine follow-up with surveillance imaging can assist in treating recurrent symptoms.

A recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision: a case report and review of the literature.

Benign multicystic peritoneal mesothelioma is a rare cystic tumor with approximately 140 cases reported to date. It is found mainly in women of reproductive age and is commonly attached to the serosal surface of pelvic viscera. The pathogenesis is uncertain and debate regarding its neoplastic or reactive nature exists. The presenting symptoms are often nonspecific and most commonly include vague lower abdominal pain and fullness. Imaging studies are used to identify the lesion, but histologic studies with the aid of immunohistochemical techniques are needed for definitive diagnosis as the differential diagnosis is quite extensive. Surgical resection is the primary form of treatment, and follow-up is important due to the high rate of recurrence and the rare possibility of malignant transformation. Here, we present a case of a 50-year-old female with a recurrence of benign multicystic peritoneal mesothelioma treated through laparoscopic excision and also a review of the literature.