Non-intubated vs. intubated video-assisted thoracoscopic bullectomy - a retrospective cohort study.

INTRODUCTION: Thoracic surgery procedures evolved enormously over time from open surgery to video assisted thoracoscopic surgery (VATS) and now non-intubated uniportal VATS. At our centre, the initial approach for bullectomy was by uniportal intubated VATS (iVATS) for most cases. Only in mid-2020, in the midst of COVID-19 pandemic, uniportal non-intubated VATS (NiVATS) took precedence. We compared the outcome of bullectomy via iVATS versus NiVATS for a period of 5 years. MATERIALS AND METHODS: We reviewed the medical records of all patients that underwent bullectomy from 1st June 2017 to 31st May 2022. Mann Whitney U-test was completed for all variables. Primary objective was to compare operating time (OT), global operating time (GOT), post-operative length of stay (LOS) and complication rate. RESULTS: A total of 90 bullectomies performed in which 36 were approached via iVATS and 54 NiVATS. It was found that the post-operative LOS, GOT, and OT were significantly shorter in the NiVATS as compared to iVATS. Complication rate between both groups showed no significant difference. CONCLUSION: NiVATS bullectomy demonstrated a safe and reliable alternative surgical approach with superior surgical outcome than iVATS bullectomy.

Tracheal resection and reconstruction: A 3-year case series of 14 patients.

INTRODUCTION: Tracheal resection and reconstruction is one of the most challenging procedures and is seldom performed due to its complexity. Despite being a life-saving procedure, only a handful of centres are performing this procedure in Malaysia. We report our 3 years' experience in Hospital Kuala Lumpur performing tracheal resection and reconstruction in 14 patients. MATERIALS AND METHODS: Retrospective review of medical records of tracheal resection and reconstruction was performed from September 2018 till August 2021. Data that were extracted include demographic information, indication for surgery, intraoperative airway management, surgical approach, perioperative parameters, complications, and 1- year outcome. RESULTS: Fourteen patients with the mean age of 49.1 years underwent tracheal resection and reconstruction, consisting of 9 benign and 5 malignant diseases. Non-intubated airway approach was used in three patients. Transcervical surgical access was used in 10 patients whereas thoracotomy, videoassisted thoracoscopic surgery, and combination of thoracotomy, transcervical incision with manubrial split were used in 3 patients respectively. The mean length of trachea resected was 2.3cm, with the longest length of 4.5cm. All patients were extubated post-operatively except for one due to traumatic brain trauma. No anastomosis dehiscence was seen. We also did not see any postoperative stenosis and all the patients are alive. CONCLUSION: Tracheal resection and anastomosis can be performed safely in complex stenosis and malignant tumours. Pre-operative planning with a multidisciplinary approach is vital to ensure a good outcome.

Surgical subspecialty training outside Malaysia during COVID-19 Pandemic: Perspectives and experiences of Trainees.

Subspecialty surgical training is an integral part of continuous professional development. It represents a unique opportunity for surgeons to enhance and develop specific advanced skills in their sub-disciplines. Hence, hands-on training in an international training centre abroad allows one to bring home new technical and management skills in the expansion of Malaysian surgical services to raise to be on par with the international standards. The unexpected onset of the COVID-19 pandemic brought in previously unknown hindrances to the training both locally and abroad but our success in engagement with international centres despite the pandemic restrictions serves as a valuable experience towards maintaining international networking for future collaborations.

Uniportal video assisted thoracoscopic surgery right upper sleeve lobectomy- The first experience in Hospital Kuala Lumpur.

Sleeve lobectomy is a lung sparing surgery and is the preferred alternative to pneumonectomy for centrally located tumours, which has less postoperative morbidity and mortality. Surgical approach for the technically demanding sleeve lobectomy evolved over the decades from conventional thoracotomy to video assisted thoracoscopic surgery (VATS) to uniportal VATS (uVATS) which allows for quicker recovery and less pain postoperatively. We report our very first successful uVATS sleeve right upper lobectomy performed in the Hospital Kuala Lumpur, Malaysia.