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OBJECTIVES Although video-assisted thoracic surgery (VATS) has shortened hospitalization duration for non-small-cell lung cancer (NSCLC) patients, the factors associated with early discharge remain unclear. This study aimed to identify patients eligible for a 72-h stay after VATS anatomical resection. METHODS Monocentric retrospective study including all consecutive patients undergoing VATS anatomical resection for NSCLC between February 2010 and December 2019. Two groups were defined according to the discharge: ‘early discharge’ (within 72 postoperative hours) and ‘routine discharge’ (at >72 postoperative hours). RESULTS A total of 660 patients with a median age of 66.5 years (interquartile range 60–73 years) (female/male: 321/339) underwent VATS anatomical pulmonary resection for NSCLC [segmentectomy in 169 (25.6%), lobectomy in 481 (72.9%), bilobectomy in 8 (1.2%) and pneumonectomy in 2 (0.3%) patients]. The cardiopulmonary and Clavien–Dindo III–IV postoperative complication rates were 32.6% and 7.7%, respectively. The median postoperative length of stay was 6 days (interquartile range 4–10 days). In total, 119 patients (18%) could be discharged within 72 h of surgery. On multivariable analysis, the factors significantly associated with an increased likelihood of early discharge were: body mass index >20 kg/m2 [odds ratio (OR) 2.37], absence of prior cardiopathy (OR 2), diffusing capacity of the lung for carbon monoxide >60% (OR 1.82), inclusion in an enhanced recovery after surgery protocol (OR 2.23), use of a single chest tube (OR 5.73) and postoperative transfer to the ward (OR 4.84). Factors significantly associated with a decreased likelihood of early discharge were: age >60 years (OR 0.53), American Society of Anaesthesiologists score >2 (OR 0.46) and use of an epidural catheter (OR 0.41). Readmission rates were not statistically different between both groups (5.9% vs 3.1%; P = 0.17). CONCLUSIONS Age, pulmonary functions and comorbidities may influence discharge after VATS anatomical resection. The early discharge does not increase readmission rates.

Introduction VATS pulmonary segmentectomy is increasingly proposed as a parenchyma‐sparing resection for tumors smaller than 2 cm in diameter. The aim of this study was to compare short‐term oncological results and local control in solid non‐small cell lung cancers (NSCLCs), This study analyzes the short‐term oncological results and local control of solid NSCLC smaller than 2 cm, surgically treated by intentional VATS segmentectomy or lobectomy. Despite the short follow‐up, our preliminary data shows that local control is comparable for VATS lobectomy and VATS segmentectomy for patients with NSCLC

Recurrence after pulmonary metastasectomy (PM) is frequent, but it is unclear to whom repeated pulmonary metastasectomy (RPM) offers highest benefits. Retrospective analysis of oncological and post-operative outcomes of consecutive patients who underwent PM from 2003 to 2018. Overall survival (OS) and disease-free interval (DFI) were calculated. Cox regression was used to identify variables influencing OS and DFI. In total, 264 patients (female/male: 114/150; median age: 62 years) underwent PM for colorectal cancer (32%), sarcoma (19%), melanoma (16%) and other primary tumors (33%). Pulmonary metastasectomy was approached by video-assisted thoracic surgery (VATS) in 73% and pulmonary resection was realized by non-anatomical resection in 76% of cases. The overall median follow-up time was 33 months (IQR 16–56 months) and overall 5-year survival rate was 62%. Local or distant recurrences were observed in 172 patients (65%) and RPM could be performed in 66 patients (25%) for a total of 116 procedures. RPM was realized by VATS in 49% and pulmonary resection by wedge in 77% of cases. In RPM patients, the 5-year survival rate after first PM was 79%. Post-operative cardio-pulmonary complication rate (13% vs. 12%; p = 0.8) and median length of stay (4 vs. 5 days; p = 0.2) were not statistically different between first PM and RPM. Colorectal cancer (HR 0.56), metachronous metastasis (HR 0.48) and RPM (HR 0.5) were associated with better survival. In conclusion, our results suggest that RPM offers favorable survival rates without increasing post-operative morbidity.

Objective Video-Assisted Thoracic Surgery (VATS) is now the preferred approach for standard anatomical pulmonary resections. However, operative time (OT) for this technique is correlated to many aspects, such as the surgical complexity or the surgeon’s experience and skills. The aim of this study was to identify the factors associated with prolonged OTs and to assess the impact of OT on the development of post-operative complications after VATS anatomical pulmonary resections. Methods Retrospective monocentric study including all consecutive patients undergoing a VATS anatomical pulmonary resection for benign or malignant lesions between January 2010 and December 2019. Postoperative outcomes were compared between short ( Results A total of 836 patients underwent a VATS anatomical pulmonary resection for malignant (n = 767, 91.7%) or benign (n = 69, 8.3%) lesions. Lobectomies were performed in 555 (66.4%), segmentectomies in 250 (29.9%), sleeve lobectomies in 16 (1.9%), bilobectomies in 11 (1.3%) and pneumonectomy in 4 (0.5%) patients. The conversion rate to thoracotomy was 7.7%. Of those 836 patients, 495 (59.2%) were operated within 150 minutes. During the 30-postoperative day period, the overall morbidity was significantly lower in the short OT group (29.1% vs. 40.5%; p = 0.001). Both the duration of drainage (3 vs. 4 days; p Conclusion A prolonged OT is an individual risk factor for postoperative complications in patients undergoing VATS anatomical pulmonary resection.

Bronchial atresia (BA) is a rare congenital pulmonary airway malformation. It is characterized by the focal stenosis of a proximal segmental bronchus associated with peripheral mucus impaction and hyperinflation of the obstructed lung segment. Most cases are identified during neonatal period or childhood. When diagnosed in adults, BA may present with recurrent infections, pneumothorax and destruction of affected parenchyma. Thoracoscopic approach to BA has proved challenging in adult patients because of repeated infections and subsequently, its inflammatory status. Herein we present a case of a 26-year-old female with left side recurrent pneumonia and pneumothorax past history. A chest computed tomography revealed a complex congenital bronchial atresia involving the left upper lobe and basal segments, associated to vascular anomalies. She underwent a successful uniportal VATS left upper lobectomy and resection of basal segments. Uniportal VATS approach is an effective and safe treatment for the management of complex congenital lung malformation.

Uniportal VATS posterolateral segmentectomy (S9 and S10) can be an option for treatment of early-stage lung cancer or in cases of central metastases. Lower lobe segmentectomy is challenging because the pyramidal shape of the basilar segments makes the identification of the intersegmental plane difficult, and the segmental arterial and venous supply is highly variable. Although identifying the segmental arterial branches is easier with a fissure-based technique, the ligamentum-based approach has emerged as a valid and safe alternative in cases of fused fissure. This video tutorial illustrates the technical aspects of the uniportal VATS ligamentum-based S9+10 segmentectomy of the right lower lobe.

Early-stage lung cancer is increasingly being managed by sublobar resection, which offers equivalent oncological results to lobectomy for lesions of less than 2 cm. However, isolated resection of the laterobasal segment (S9) is a difficult procedure and has rarely been reported via a uniportal video-assisted thoracoscopic (VATS) approach. The two key challenges are, first, the segmental arterial supply is deeply located in the lung parenchyma, making the dissection difficult, and second, the cuboidal shape of the lateral basilar segment hampers the identification of the intersegmental plane.

Posterolateral bisegmentectomies of the lower lobe (segments 9 and 10) are challenging procedures when performed by uniportal VATS, primarily for the following reasons: first, the cuboidal shape of the basilar segments makes the identification of the intersegmental plane difficult, and second, the segmental arterial and venous supplies are deeply located and highly variable. The fissure-based dissection, combined with the intersegmental tunneling method, emerges as the safest approach to accomplish accurate identification of the vascular pattern and radical removal of interlobar lymph nodes. The purpose of this video tutorial is to illustrate the technical aspects of the fissure-based uniportal left S9+10 segmentectomy using the intersegmental tunneling method.

The goal of surgical treatment of thoracic outlet syndrome is to decompress the thoracic outlet. There is no consensus regarding the surgical approach. Thoracic outlet decompression can be performed by direct open transaxillary, supraclavicular, and infraclavicular procedures, and the decision regarding which to choose can be a difficult one. Recently, the thoracoscopic approach has become an alternative to the classic open approach. This video tutorial demonstrates first rib resection by VATS for thoracic outlet syndrome and explains the technical aspects of the procedure.

Resumen La extirpacion quirurgica del bocio intratoracico puede realizarse a traves de un abordaje cervical en la mayoria de los pacientes. La revision de la literatura pone de manifiesto que los cirujanos experimentados precisan un abordaje extracervical en el 2-3% de los casos. A pesar de que el tratamiento quirurgico del bocio retroesternal esta bien definido, existe poca informacion acerca del abordaje quirurgico de los bocios intratoracicos que se extienden mas alla del cayado aortico hacia el mediastino posterior. Presentamos 2 casos y proponemos una combinacion de incision cervical y toracotomia lateral con preservacion muscular para la reseccion del bocio en el mediastino posterior. En este tipo de casos descartamos el uso de la esternotomia puesto que el mediastino posterior resulta inaccesible debido a la presencia del corazon y grandes vasos por delante de la masa tiroidea, lo cual podria llevar a realizar una peligrosa diseccion a ciegas. Segun nuestra experiencia el abordaje transcervical combinado con la toracotomia esta indicado para una reseccion completa y segura del bocio situado en el mediastino posterior.

Surgical removal of intrathoracic goiter can be performed by a cervical approach in the majority of patients. Review of literature shows that experienced surgeons need to perform an extracervical approach in 2-3% of cases. In spite of surgical management of substernal goiter is well defined, there is little available information about surgical approach of intrathoracic goiters extending beyond the aortic arch into the posterior mediastinum. We report two cases and propose combination of cervical incision and muscle-sparing lateral thoracotomy for posterior mediastinal goiter removal. In such cases, we do not favour sternotomy as posterior mediastinum is inaccessible due to the presence of heart and great vessels anterior to the thyroidal mass that would lead to perform a perilous blind dissection. Based in our experience, transcervical and thoracotomy approach is indicated for a complete and safe posterior mediastinal goiter removal.