[Deficit of trainees in thoracic surgery : Do we need to adapt or become extinct?] / Nachwuchsmangel in der Thoraxchirurgie : Müssen wir uns anpassen oder aussterben?

BACKGROUND: Although thoracic surgery is a challenging and versatile surgical specialty, a shortage of qualified and motivated thoracic surgery residents is expected in the coming years. In the inpatient setting, a shortage of approximately 7300 surgeons is expected. Therefore, there is an urgent need to attract more interested young medical students and improve the medical training of our next generation of surgeons. METHODS: To assess the current nationwide status quo among medical students, an online survey with 39 questions on participant demographics, medical education, interest in surgical and thoracic surgery training, and attractiveness of residency was designed. RESULTS: In all, 224 questionnaires were analyzed. Overall, there was a high level of interest in (thoracic-) surgery at the start of training. It should be noted that one third of the respondents did not know that the 'thoracic surgeon' is an independent specialist. This statement raises further questions about the presence of thoracic surgery in medical studies. When asked about typical characteristics that students associate with thoracic surgery, the majority answered 'a high level of practical activity'. The main reason they gave for not pursuing further surgical training was the unfavorable work-life balance. CONCLUSION: Students know exactly what they want for their future and where surgery has its weaknesses. They want transparent and practical training, a work-life balance, and recognition of their work and themselves.

Robotic thoracic surgery for neurogenic tumors.

OBJECTIVE: Thoracic neurogenic tumors usually present as benign nerve sheath tumors that can be resected via transthoracic or posterior approaches, depending on the anatomical location. Robot-assisted thoracic surgery (RATS) is increasingly being used for the transthoracic approach, but evidence is very limited. The authors initiated the current study to evaluate the efficacy and safety of RATS for thoracic neurogenic tumors. METHODS: This retrospective study is based on a prospectively created database that includes all RATS surgeries between 2018 and 2023. All patients with histologically confirmed neurogenic tumors were included in the study. The patients' medical and surgical records as well as radiological and pathological findings were analyzed. RESULTS: During a 5-year period, 27 patients underwent robotic resection of neurogenic tumors at a high-volume thoracic surgery center. Two patients had previously undergone posterior laminectomy for resection of the intraspinal components. The pathologies included schwannomas (18, 64%), ganglioneuromas (8, 29%), 1 paraganglioma, and 1 neurofibroma occurring close to a schwannoma unilaterally in the same patient. The median tumor size was 4.7 cm (range 0.9-11.4 cm). The median operating time was 69 minutes (range 27-169 minutes), and the median postoperative stay was 3 days (range 1-19 days). There was one conversion due to adhesions after a previous surgery. No major bleeding occurred. There was no perioperative mortality. Morbidity included a lymphatic fistula (n = 1), pneumonia (n = 1), prolonged air leak (n = 1), and 4 cases of postoperative pain persisting for more than 4 weeks. Neurological complications were mostly observed in patients with tumors located at the thoracic apex: 2 cases of Horner's syndrome, 2 cases with compensatory hyperhidrosis, 1 patient with paresis of the recurrent laryngeal nerve, and a T1 lesion resulting in a minor motor deficit of the small hand muscles (Medical Research Council grade 4) and hypoesthesia of the respective dermatome. CONCLUSIONS: RATS for thoracic neurogenic tumors is feasible and safe. Tumors at the thoracic apex are at high risk of neurological deficit and should be approached with care. Close interdisciplinary collaboration between neurosurgeons and thoracic surgeons is necessary for optimal patient selection and a good postoperative outcome.

Analysis of Carbon Nanoparticle Coatings via Wettability.

Wettability, typically estimated through the contact angle, is a fundamental property of surfaces with wide-ranging implications in both daily life and industrial processes. Recent scientific interest has been paid to the surfaces exhibiting extreme wettability: superhydrophobic and superhydrophilic surfaces, characterized by high water repellency and exceptional water wetting, respectively. Both chemical composition and morphology play a role in the determination of the wettability "performance" of a surface. To tune surface-wetting properties, we considered coatings of carbon nanoparticles (CNPs) in this study. They are a new class of nanomaterials synthesized in flames whose chemistry, dimension, and shape depend on combustion conditions. For the first time, we systematically studied the wettability of CNP coatings produced in a controlled rich ethylene/air flame stabilized over a McKenna burner. A selected substrate was intermittently inserted in the flame at 15 mm above the burner to form a thin coating thanks to a thermophoretic-driven deposition mechanism. The chemical-physical quality and the deposed quantity of the CNPs were varied by opportunely combing the substrate flame insertion number (from 1 to 256) and the carbon-to-oxygen ratio, C/O (from 0.67 to 0.87). The wettability of the coatings was evaluated by measuring the contact angle, CA, with the sessile drop method. When the C/O = 0.67, the CNPs were nearly spherical, smaller than 8 nm, and always generated hydrophilic coatings (CA < 35°). At higher C/O ratios, the CNPs reached dimensions of 100 nm, and fractal shape aggregates were formed. In this case, either hydrophilic (CA < 76°) or superhydrophobic (CA ~166°) behavior was observed, depending on the number of carbon nanoparticles deposed, i.e., film thickness. It is known that wettability is susceptible to liquid surface tension, and therefore, tests were conducted with different fluids to establish a correlation between the flame conditions and the nanostructure of the film. This method offers a fast and simple approach to determining mesoscale information for coating roughness and topographical homogeneity/inhomogeneity of their surfaces.

Rotor-Stator Emulsification in the Turbulent Inertial Regime: Experiments toward a Robust Correlation for the Droplet Size.

The Sauter mean diameter, d32, is a representative parameter in emulsions that indicates the average size of the oil droplets once the emulsion becomes stable. Several mathematical and physical approaches have been employed in the literature to seek expressions for d32 under different conditions. The present work sheds light on this rich literature and emphasizes that the characterization of emulsions is still a fertile field for investigation. In this paper, a new Π-theorem-based model to predict the normalized Sauter mean diameter for the specific case of rotor-stator emulsification is sought by applying a multiple regression analysis on experimental data of oil-in-water (O-W) emulsions produced using three different oils: paraffin, soybean oil, and isopropyl myristate, at different oil-to-water (O/W) ratios and rotor speeds. The proposed model quantifies the roles of the viscous, inertial, and interfacial tension forces, besides the O/W ratio, in the emulsification process within the turbulent inertial subrange. The developed empirical correlation is then contrasted with relevant literature models for reliability assessment; predictions of the present explicit model are proven to be more accurate for the fluid properties and the experimental conditions under study.

Multimodal therapy of epithelioid pleural mesothelioma: improved survival by changing the surgical treatment approach.

Background: The exact role and type of surgery for malignant pleural mesothelioma (MPM) remains controversial. This study aimed at analyzing a 20-year single center perioperative experience in MPM surgery at our high-volume thoracic surgery center and comparing the overall survival after trimodal extrapleural pneumonectomy (EPP) and extended pleurectomy and decortication combined with hyperthermic intrathoracic chemoperfusion (EPD/HITOC) and adjuvant chemotherapy with that after chemotherapy (CTx) alone. Methods: Patients with epithelioid MPM treated with neoadjuvant chemotherapy, EPP and adjuvant radiotherapy within a trimodal concept or EPD/HITOC in combination with adjuvant chemotherapy between 2001 and 2018 were included in this retrospective analysis. Surgical cohorts were compared to patients treated with standard chemotherapy. Results: Overall, 182 patients (69 EPP, 57 EPD/HITOC, 56 CTx) were analyzed. Due to occupational exposure to asbestos for most of the patients, 154 patients (84.6%) were male. The patients in the surgical cohorts were significantly younger than those in the CTx cohort. There was no significant difference between the proportion of patient age and side. The median overall survival of the EPD/HITOC cohort with 38.1 months was significantly longer than that of the EPP and CTx cohorts (24.0 and 15.8 months). Better survival was significantly associated with an ECOG 0 performance status, age below 70 years, and negative lymph node status. In the multivariate analysis, EPD/HITOC was significantly associated with improved overall survival. Perioperative morbidity was lower in the EPD/HITOC group than in the EPP cohort. Conclusions: EPD/HITOC is feasible and safe for localized epithelioid pleural mesothelioma. Changing the surgical approach to a less radical lung-sparing technique may improve overall survival compared to trimodal EPP.

Rib-oriented Thoracoscopic Sympathetic Surgery for Hyperhidrosis: Prospective Long-term Results and Quality of Life.

BACKGROUND: The optimal thoracoscopic sympathetic surgery for primary palmar and/or axillary hyperhidrosis (PPAH) is still unclear because of lack of uniform technique and qualitative/quantitative scales for definition of results. The aims of this study were to compare long-term outcomes based on the surgical technique and the level of sympathetic trunk interruption by clipping and to assess postoperative compensatory sweating (CS), patients' satisfaction, and quality of life (QoL). MATERIALS AND METHODS: Between September 2009 and April 2016, 94 patients who underwent 2-stage bilateral thoracoscopic rib-oriented (R) sympathetic clipping were prospectively followed up through the administration of standardized preoperative and postoperative questionnaires.Thirty-four (36.2%) patients underwent single-port transaxillary access instead of the standard two 5-mm incisions. The level of sympathetic clipping for PPAH was R3+4(top and bottom); in patients who complained associated facial or plantar hyperhidrosis R2-bottom and R5-top were clipped, respectively. Seventy-five patients completed bilateral surgery. RESULTS: There were no significant differences between single-port and biportal video-assisted thoracoscopic surgery in terms of operative times and postoperative results. At a mean follow-up of 72 (SD: 26) months, CS was reported in 42 (56%) patients, severe only in 6 (8%). It was higher in the case of R2-bottom clipping (P=0.03). Thirty-one of 60 (51.6%) patients who had a plantar hyperhidrosis declared an improvement of feet sweating after surgery. Postoperative satisfaction was excellent (86.11% on a 0 to 100 scale) and 95.4% of patients declared an improvement in QoL, which was statistically significant in all evaluated parameters. These results were not related to the level of clipping. CONCLUSION: Thoracoscopic R3 to R4 clipping appears to be a safe and effective treatment for PPAH. Although postoperative CS was common and higher after R2-bottom clipping, this did not seem to affect patients' satisfaction and improvement in QoL.