Kyobu geka. The Japanese journal of thoracic surgery最新文献

In lung cancer surgery, when tumors are present in the branches of the bronchus, it may be appropriate to perform suture closure by sharply separating the bronchus, rather than using an autosuture device to ensure adequate margins. While robot-assisted thoracic surgery (RATS) simplifies needle handling compared to video-assisted thoracic surgery (VATS), ligation remains challenging due to the lack of tactile feedback. To ensure closure of the bronchial segment by ligation in robotic surgery, we started a preliminary study to use dual barbed sutures that do not require ligation and clips for ligature fixation after the approval from the Ethics Committee of Mie University Hospital. We performed this procedure in five patients from January 2024 to present. Postoperative bronchoscopy, performed in four of the five patients, confirmed the bronchial stump was well closed in all cases, with no evidence of bronchopleural fistula( BPF). However, two patients experienced prolonged hospitalization due to midlobar torsion and prolonged air leakage requiring pleurodesis, respectively. The preliminary results suggest that this novel technique provides reliable bronchial stump closure in RATS. We plan to conduct a larger cohort study with long-term follow-up to further confirm the safety and long-term BPF rate.

Sleeve lobectomy remains one of the most challenging procedures in thoracic surgery. To date, reports on robotic-assisted thoracic surgery (RATS) sleeve lobectomy are limited, with most literature focusing on right upper lobe reconstructions. Notably, even Cerfolio's landmark reports do not detail bronchial wedge resection or sleeve lobectomy of the middle and lower lobes. Using a 0° scope with an upward-viewing technique allows for the observation of target bronchi in the middle and lower lobes from a low intrathoracic angle. Although the interlobar pulmonary artery often obstructs the bronchial view in this approach, strategic retraction of the artery and lung parenchyma creates sufficient space for precise robotic anastomosis. The robotic platform provides a three-dimensional (3D) magnified view and enhanced dexterity, facilitating complex suturing even in narrow spaces. This surgical approach and the specific tips for field exposure may facilitate the wider adoption of minimally invasive bronchoplasty across various institutions.

A 72-year-old man was diagnosed with gastric cancer. Preoperative chest computed tomography (CT) revealed three nodules in the right lung. The patient had no history of malignant disease and had undergone surgery for thyroid follicular adenoma six years previously. Based on the morphology of the nodules, the right lower lobe nodule was suspected to be a primary lung cancer, whereas the right upper and middle lobe nodules were suspected to be lung metastases secondary to lung or gastric cancer. After distal gastrectomy, thoracoscopic wedge resection was performed for the pulmonary nodules. The right lower lobe pulmonary nodule was diagnosed as primary lung cancer, and the right upper and middle lobe pulmonary nodules were diagnosed as lung metastases from thyroid follicular carcinoma. When a patient with a history of thyroid follicular adenoma presents with a lung nodule, lung metastasis from thyroid follicular carcinoma should be considered.

Right-sided infective endocarditis( IE) is rare, accounting for 5~10% of all cases. Herein, we report a 70-year-old man who developed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and tricuspid valve endocarditis (TVE) with severe tricuspid regurgitation (TR) following bladder fistula placement. Echocardiography revealed a 17×14 mm vegetation on the septal leaflet. Despite antibiotic therapy, the symptoms of heart failure worsened and surgery was indicated. Under cardiopulmonary bypass, the infected anterior and septal leaflets were excised, and valve reconstruction was performed using glutaraldehyde-treated autologous pericardium. Postoperative echocardiography revealed mild TR. The patient underwent prolonged antibiotic therapy and was discharged in good condition. At two years follow-up, there was no recurrence of infection or worsening of TR. This case suggests that autologous pericardial patch repair is a useful strategy for MRSA-associated TVE, particularly in patients with a high reinfection risk, where prosthetic material should be avoided.

Cardiac surgery after retrosternal gastric tube reconstruction presents significant technical challenges because of interference with the median sternotomy approach. We report a 67-year-old man who successfully underwent aortic valve replacement and mitral valve repair a year after subtotal esophagectomy with retrosternal gastric tube reconstruction for esophageal cancer. The gastric tube was carefully mobilized using a combined laparoscopic and cervical approach, allowing safe median sternotomy without injury to the right gastroepiploic artery. Both valve procedures were completed successfully under cardiopulmonary bypass. The patient resumed oral intake on postoperative day 4 and was transferred for rehabilitation on day 15. This case illustrates that with elaborate preoperative planning and careful intraoperative management, complex cardiac surgery can be performed safely even after retrosternal gastric tube reconstruction.

An 80-year-old woman underwent mitral valve replacement, tricuspid annuloplasty, and left atrial plication for symptomatic mitral stenosis, tricuspid regurgitation, and atrial fibrillation. Following admission to the intensive care unit, she developed low-output syndrome. Transthoracic echocardiography showed extensive apical asynergy, and electrocardiography showed negative T waves in leads Ⅱ, Ⅲ, aVF, and V2-V6. Coronary angiography demonstrated no significant coronary artery stenosis, whereas left ventriculography showed basal hyperkinesis with apical asynergy, leading to a diagnosis of Takotsubo cardiomyopathy. Although hemodynamic stabilization was difficult, the patient's condition gradually improved with catecholamine therapy alone, which was discontinued on postoperative day 11. In cases of postoperative acute-onset low-output syndrome, the possibility of Takotsubo cardiomyopathy should be considered.

A 70-year-old male was diagnosed with a ventricular aneurysm at the apex. The aneurysm was large, measuring 77 mm, so surgery was performed. We performed the operation to prevent rupture and improve low cardiac function, following the septal anterior ventricular exclusion procedure. Postoperative pathological examination revealed that the protruding wall on the right ventricular side consisted of fibrous tissue with sclerosis and a small amount of myocardial tissue, leading to a diagnosis of a pseudo-false aneurysm. Postoperative cardiac function improved, with the ejection fraction (EF) increasing from 24% to 45%. Left ventricular pseudo-false aneurysm is rare, and we report this case including the review of the literature.

We report a rare case of primary pulmonary meningioma in a 52-year-old woman. A right middle lobe pulmonary nodule was first detected on chest X-ray at the age of 38. Chest computed tomography (CT) suggested a pulmonary hamartoma, and the patient was followed conservatively. Because the nodule gradually enlarged over time, a partial resection of the right middle lobe was performed by videoassisted thoracoscopic surgery for diagnostic and therapeutic purposes. Histopathological examination revealed a meningioma. Meningiomas are the most common tumors of the central nervous system, however, ectopic meningiomas, including those occurring in the lung, are rare.

An 81-year-old man underwent surgical aortic valve replacement (SAVR) for stenotic bicuspid valve with a 21-mm CEP bioprosthesis 17 years ago. Four years ago, he underwent valve-in-valve (ViV)transcatheter aortic valve replacement (TAVR) using a self-expandable Evolut R 23-mm valve due to structural valve deterioration (SVD) and redo SAVR was indicated because of repeat SVD and heart failure symptoms. Transcatheter valve and prior surgical valve adhered to the anterior mitral leaflet. Removal of the valve caused perforation, which required repair. Aortic valve replacement was performed using an Epic Plus 21-mm valve. SAVR after TAVR is more invasive and has higher mortality than ViV, but in younger or low-risk patients, treatment should be planned with long-term prognosis in mind.

With the increasing adoption of robot-assisted thoracic surgery( RATS), the role of surgical assistants has evolved compared to traditional open or video-assisted thoracic surgery( VATS). At our institution, a 5-port look-up view approach with the da Vinci Xi system has been in use since May 2021, and since June 2024, we have transitioned to a solo-surgery approach in which the primary surgeon independently manages both console operation and surgical field exposure. In this retrospective single-center study, we quantitatively evaluated assistant interventions in 115 cases during the introduction phase and 45 cases during the solo-surgery phase. Assistant interventions such as suctioning and retraction significantly decreased in the solo-surgery phase, while port hopping-a technique allowing instrument switching by the surgeon-was introduced as an alternative. No conversions to thoracotomy or blood transfusions occurred throughout the study period. These findings suggest that, with appropriate strategies and technical adaptations, solo-surgery in RATS is not only feasible but can be performed safely without compromising operative outcomes.