Corso di chirurgia toracica videoassistita e robotica – Day 1

awesome Napoles

Naples, Italy

Hospital Monaldi
Hospital Monaldi

No sign yet of the elusive Dr. Diego Gonzalez Rivas and Dr. Henrik Hansen, but they are both scheduled to speak (and operate) on the second day of the conference.

Instead, there were several local speakers to address the exclusively Italian crowd of surgeons, nurses and therapists.  Several staff members at Hospital Monaldi, along with the past and current president of the Italian Society of Thoracic Surgery gave some opening remarks before starting the conference with several lectures on pre-operative and post-operative care.

Dr. Carlo Curcio was among the opening speakers and is the Director of this event.

Dr. Carlo Curcio talks about the history of minimally invasive surgery at Hospital Monaldi

During Dr. Curcio’s introduction, he discussed the fact that the thoracic surgery department at Monaldi were late adopters to video-assisted thoracoscopic surgery.  In fact, the first VATS procedure was performed just a few short years ago in 2011.  This makes it more remarkable to note that the department now performs over 80% of cases by VATS.   As such ready converts, learning and applying the uniportal technique should be relatively painless.

The remainder of the  morning lectures discuss topics in pre-anesthesia evaluation, pre-operative cardiac evaluation and post-operative care.  Not much new ground is covered here, but the speakers acquit themselves with their through knowledge of the topic.

Dr Nespoli, Anesthesiologist talks about pre-anesthesia evaluation and stratifying global risk
Dr Nespoli, (Anesthesiologist) talks about pre-anesthesia evaluation and stratifying global risk

Dr. Nespoli did a nice job of bringing in functional status & quality of life indications as part of the evaluation to predict post-operative complications.  I always think that as medical professionals we tend to dress it up and overly complicate matters when we start relying on numbers such as Vo2 in addition to FEV1, DLCO and the like.  I think inclusion of the 6 minute walk test, stair climbing and the shuttle walking test give a more global indication of the patient’s overall status which can be sometimes overlooked.  (As noted by some of my peers, it’s fine if the DLCO is acceptable for surgical reception, but if you can not motivate your patient to perform the 6 minute walk as part of their pre-operative evaluation, then you should expect a whole host of post-operative complications).

The chair of cardiology spoke about cardiac evaluation – when to perform echocardiogram, exercise stress testing and when to proceed to move invasive measures such as coronary angiography.  He also gave a thumbnail sketch of current strategies for patients on anti-platelets and similar therapies after prior revascularization (CABG, BMS, DES).

A nice portion of the morning was set aside for lectures regarding both pre and post-operative physical and pulmonary rehabilitation along with a discussion of the evaluation of the surgical literature relating to their therapies.  As readers know, I think that both of these therapies (pulmonary rehabilitation more so) are essential in our lung patients, so it was good to see support for the specialties and services.

The remainder of the morning was dedicated to post-operative management strategies and the prevention of common complications.  There was a nice talk about the use of intrathecal pain management after thoracic surgery by Dr. Rispoli but, in general, we have talked about much of this content in-depth at the site before, so I won’t go into detail again here.

For the same reasons, I didn’t even take notes at the lectures comparing VATS to open surgical techniques.  There is such a wealth of existing data supporting the use of VATS even in surgical oncology that we don’t need to review that argument yet again.

Thoracic surgery nurses at Hospital Monaldi
Thoracic surgery nurses at Hospital Monaldi