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Objective Clinical adoption of robotic lobectomy for management of lung cancer is rapidly increasing across the world. Several studies have evaluated the technique with regards to perioperative and cost outcomes, with evidence beginning to grow regarding long-term oncologic outcomes. We report perioperative and oncologic outcomes in our single institution experience with 500 consecutive robotic lobectomies, including a significant portion for locally advanced disease. Methods This study is a retrospective review of the first 500 robotic lobectomies performed at our institution from 2010 to 2018. Segmentectomy, pneumonectomy, and lobectomy for other conditions were excluded. Descriptive statistics and Kaplan-Meier survival analysis are presented. Results Pathologic stage distribution was IA in 194 (39%), IB in 54 (11%), IIA in 41 (8%), IIB in 109 (22%), IIIA in 83 (17%), IIIB in 11 (2%), and IV in 8 (2%). Elective conversion occurred in 26 cases (5.2%) and emergent conversion occurred in 3 cases (0.6%). Mean length of stay was 3.7 days (1 to 40). The most common complications encountered were atrial fibrillation in 71 (14.2%) and prolonged air leak in 49 (9.8%). Thirty-day mortality occurred in 3 patients (0.6%). Nodal upstaging was 16.6%. Stage specific overall survival outcomes included an 84% survival for stage IA patients, 73% for IB, 68% for IIA, 63% for IIB, and 49% for IIIA disease. Conclusions Robotic lobectomy for lung cancer is a feasible technique for treatment of non-small cell lung cancer with low perioperative morbidity and mortality. Furthermore, excellent oncologic outcomes can be achieved with this approach.

Aortic fenestration has been used at our institution since 1973. The indications for this procedure and the technique have evolved, now being exclusively performed for patients with acute limb and/or organ ischemia secondary to descendingaorticdissection.Paramounttothesuccessofthis procedure is early recognition and quick intervention to avoid irreversible end-organ damage andfixed thrombosis in the false lumen. Physical examination and diagnostic computed tomography can aid in obtaining a quick diagnosis. Contraindications to aortic fenestration include delayed diagnosis (after 48 hours the success of re-establishing perfusion is low secondary to thrombus burden). Also fenestration should not be done in the manner described in this article unless the dissection flap reaches the level of the infrarenal aorta. Note that patients with ruptured descending aortic dissections or aneurysms can also present with malperfusion, and fenestration is contraindicated as sole therapy in this popu

r s ( a r p d d t p p ( What’s new” articles are cultivated from selected analsis of the past year’s peer-reviewed literature. Although ur knowledge and understanding of general thoracic urgical issues increased last year, enthusiasm is bridled y the few changes actually assimilated into clinical pracice. Highlights of the past year include new trends in esident education, significant trials in adjuvant therapy or lung cancer, and continued controversy in both aduvant therapy for esophageal carcinoma and noninvaive staging for lung cancer.