Guest Posts – Thoracic Surgery

Now accepting submissions for the Thoracics.org VATS International Award

The first ever Thoracics.org Award to recognize innovation and achievement in thoracic surgery is now accepting submissions.

The Thoracics.org VATS International Award

Thoracics.org is pleased to announce our first international award for innovation and achievement in thoracic surgery. This award is designed to recognize and encourage research and publication in the area of VATS, including uniportal VATS.

This award is being offered by thoracics.org for a previously unpublished paper, study or case report on any aspect of thoracic surgery involving VATS (video-assisted thoracoscopic surgery). Topics can include case reports on complex cases, use of VATS in specific populations or disease conditions, unpublished research results / retrospective analyses or similar themes.

This award will be presented at the VATS International conference in London, UK on October 20 – 21, 2017.

Award Sponsors

This year we are honored to be sponsored by VATS International and Dr. Marco Scarci.

VATS International 2017 – We’ve written about this conference in the past, so thoracics.org is very excited to be able to present the Thoracics.org award at the 2017 conference. This year’s roster of speakers and topics includes some of our favorites, as well as introducing some timely new topics such as certification in minimally invasive thoracic surgery.

VATS 2017 — The Thoracics.org award to be presented at VATS International 2017

Dr. Marco Scarci – Dr. Scarci is a thoracic surgeon at the University Hospital of London and the founder of VATS International.

Rules:

Deadline: All submissions must be received by June 1, 2017 at 8 am eastern standard time.

Authorship: Papers must be the work of a sole author, and each author may only submit one entry. Entries are limited to practicing specialty thoracic surgeons, and surgeons completing their thoracic surgery fellowships. This contest is not open to general practice surgeons, or non-thoracic surgery specialties.

Originality: All entries must consist of previously unpublished work. Evidence of prior publication of material submitted for consideration is grounds for immediate disqualification.

Entry format: Entries consist of three (3) parts; the paper, the title page and the CV. Incomplete or partial entries may be ineligible for the award.

A. Paper specifications:

Papers must be written in English.

Maximum length is ten pages double-spaced with a 12 point font.

All submissions should be in Microsoft Word or a similar PC compatible type document. No pdfs will be accepted. Multi-media materials such as photographs, or short video clips may be attached to the paper for inclusion in the on-line publishing format. Video clips should be less than 10 minutes in length. No individually identifying information should be included in submitted photographs or videos.

B. A separate title page should be included with the essay.

This title page should contain:

-Author’s name

-Contact information including physical address, email and telephone number

-Institutional or Academic affiliation(s)

-Name and contact information of immediate supervisor

C. (Optional) – Author photograph – as a separate attachment, labeled as first initial_lastname.

D. A current curriculum vitae (CV) should also be submitted as part the entry package, as a separate attachment.

Send all submissions to: k.eckland@gmail.com

Publication:

All entries are submitted for publication at thoracics.org as a guest post. These posts will be published with the author of each paper to remain anonymous until the award winner has been announced. The winner of the Thoracics.org Award will be posted on thoracics.org on August 1^st, 2017.

Following the announcement of the name of the recipient of the Thoracics.org Award, on-line articles will be amended to include author information, including name, affiliation, location and author photograph (if included with the original submission).

Judging:

Judging of the entries received will be done by a panel of thoracic surgeons. The names of the members of the panel will be revealed at the awards ceremony. While visitors to thoracics.org may comment on published entries, these comments will not be part of the judging criteria.

The Award:

The award will be presented in person at the 2017 VATS International conference in London, England.

In addition to receiving recognition within the international thoracic surgery community, the award recipient will receive*:

Complimentary registration to the 4th annual VATS International conference in London, UK. This course is one of the best courses on uniportal and minimally invasive thoracic surgery and includes content on uniportal vats, robotic surgery, awake and nonintubated surgery, and other minimally invasive techniques. The lectures are given by the masters of these techniques, including the master of uniportal surgery, Dr. Diego Gonzalez. This year’s preliminary line up of speakers and topics looks like another stimulating session of minimally invasive techniques interspersed with timely discussions on current issues in VATS (Registration courtesy of VATS International).
A copy of the new textbook, Core topics in thoracic surgery.

Core Topics in Thoracic Surgery provides accessible and concise coverage of the topics most often encountered in thoracic surgery practice. This handbook will guide the reader through revision of the topics covered in the FRCS(CTh) examination, and also covers more specialist topics in detail. In-depth technical sections offer guidance for difficult procedures, with useful commentaries from leading surgeons. A broad range of thoracic surgery issues are examined, with the latest evidence and information relevant to the speciality presented in a clear fashion. Combining an easy-to-use revision guide for trainees and a comprehensive reference text for cardiothoracic surgeons and recently appointed consultants, this is a one-stop guide to thoracic surgery. Authored by leading experts in the field, this resource will be invaluable to cardiothoracic surgeons, respiratory physicians and specialist nurses seeking to refresh or expand their knowledge of this field. (Textbook courtesy of Dr. Marco Scarci).

Additional sponsors include:

*Corporate and individuals wishing to co-sponsor this award may contact k.eckland@gmail.com

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Single port thoracoscopy for wedge resection – does size matter?

Dr. Chen discusses single port thoracoscopy – and specimen size.

Single port thoracoscopy for wedge resection – does size matter?
Dr. Chih-Hao Chen, Thoracic Surgeon, Mackay Memorial Hospital, Taiwan
Correspondence: musclenet2003@yahoo.com.tw

Case presentation and discussion

A 77 y/o woman was found to have a neoplasm in RML during routine health exam. (Full case presentation here.)
The incision was 2.5 cm. The specimen was removed successfully; patient experienced no complications and was discharged from the hospital without incident. However, when discussing this case with surgeon colleagues a specific question arose.

single port thoracoscopy — preparing to remove the specimen through the port

Does size matter? How big is too big to remove through a port incision?
An important issue is the theoretically smallest (and effective) incision size. The issue is very challenging for most surgeons. In the past, other surgeons have questioned me :
“The specimen to be removed is more than 12-15 cm. How can you remove the specimen from a 3.5 cm incision?”

BUT, the fact is “the smallest size depends mostly on the solid part of the neoplasm “.

The lung is soft in nature. In my experience, a 3.5 cm port is usually enough for any lobe. The only problem is that if the solid part is huge, pull-out of the specimen may be difficult.
Therefore, the solid part size is probably the smallest incision size we have to make, usually in the last step when dissection completed , if needed.

does size matter? — successful removal of lung specimen thru small port

single port — Port with chest tube in place

Using endo-bags to avoid larger incisions
There is an exception. I have never do this but I think it may be possible. We usually avoid opening the tumor (or cutting tumor tissue into half ) within the pleural space in order to prevent metastasis from spillage of cancerous tissue.

What if we can protect the tumor from metastasis while we cut it into smaller pieces? For example, into much smaller portions that will easily pass through the small port incisions?
My idea is to use double-layer or even triple layers of endo-bag to contain the specimen. If it is huge, with perfect protection, we cut it into smaller parts within the bag. Then the huge specimen can be removed through a very tiny incision. This is possible.

We still have to avoid “fragmentations” since this might interfere or confuse the pathologist for accurate cancer staging. Therefore, in theory, we can cut it into smaller parts but not into fragments. However this idea is worthy of consideration, and I welcome debate from my fellow surgeons and medical colleagues.

Thank you to Dr. Chen.

Dr. Dov Weissberg: Treatment of Lung Abscess

Thoracic Surgery (Cirugia de Torax. org) welcomes Dr. Dov Weissberg, noted thoracic surgeon and memoirist as our first guest commentary. Here, Dr. Weissberg comments on one of his previously published articles from 2010 on the history of lung abscess.

We at Thoracic Surgery are delighted to present Dr. Dov Weissberg, a renown thoracic surgeon with a distinguished career as a surgeon, a scholar and professor of surgery with an extensive resume and list of contributions to the field of Thoracic Surgery as our first guest commentator. Dr. Weissberg has published an exhaustive list of articles, and papers in addition to several books, including his memoirs which include his boyhood accounts of life in Poland as a hidden jew during the Holocaust, personal experiences of starvation, and his experiences as a surgeon.

He is an expert in his field, with contributions to the development of pleuroscopy and the body of knowledge surrounding a wide range of thoracic surgery topics including mediastinoscopy, thymomas, lung abscess, empyemas, traumatic thoracic injuries, tracheal disease and tracheal surgery, pleural effusions, lung cancer and lung resection.

Dr. Dov Weissberg: Treatment of Lung Abscess – commentary based on Editorial published in 2010 entitled, “The Treatment of Lung Abscess from Hippocrates to Present.

The treatment of lung abscesses has come full circle since it was first described by Hippocrates. The treatment at that time was surgical drainage (of the accumulated pus and dead tissue matter). A small tube was placed in the chest, and the accumulated pus drained out. This remained the standard of treatment until the 195o’s when the widespread use of antibiotics became popular, replacing surgery with medications. Antibiotics remained the primary treatment for this condition through the 1960’s to the 1980’s. Surgical intervention was relegated as a treatment of last resort, after multiple medication failures. In those cases, patients were usually referred for lobectomies or lung resections. On our service, (in 1980) our experiences with several patients referred for medical treatment failure showed surgical drainage to be an effective treatment and preferable over both long-term antibiotics and lung resection, thus coming back to Hippocrates. We presented these findings at several conferences, and meetings. Now in 2011; surgical drainage is once again, the treatment of choice for lung abscess.

Note: Lung resection should be reserved only for cases of extensive tissue destruction (pulmonary gangrene).

Biography of Dr. Dov Weissberg

In this particular case, with a gifted memoirist such as Dr. Weissberg, it is not possible to tell his story as well as he does.

Links:

1. The Limits of Starvation – a personal experience : Dr. Weissberg recalls his wartime experiences as a 13 year boy.

2. The Handbook of Practical Pleuroscopy (1991)

3. I Remember – memoir
4. The Holocaust – one boy’s story
5. I have chosen surgery: A surgeon’s memoir