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Background: Minimally invasive surgery (MIS) techniques, currently considered the gold standard in the treatment of early-stage non-small cell lung cancer (NSCLC), are mainly represented by video-assisted thoracoscopic surgery (VATS), both uniportal and multiportal, and by robotic-assisted thoracoscopic surgery (RATS). While multiportal RATS has been accepted as a valid alternative to VATS, carrying the advantages of three-dimensional high-definition visualisation and improved maneuverability, very few reports exist in literature on the application of uniportal RATS (U-RATS). Therefore, we describe our initial experience with this recently developed method in the treatment of early-stage NSCLC., Materials and Methods: U-RATS was conducted through a single 4 cm long antero-lateral mini-thoracotomy (ALMT) in the sixth intercostal space at the mid-axillary line. Three 8 mm robotic trocars were positioned and connected, from back to front, to robotic arms as follows: 30° camera arm, robotic arm 2 (bipolar fenestrated grasper) and 1 (Maryland bipolar forceps). Assistant access was identified as the most anterior part of ALMT., Results: Case 1: an 82-year-old woman (American Society of Anaesthesiologists [ASA III]) underwent a left S6 segmentectomy for a clinical stage IA2 NSCLC, complicated by an air leak that resolved spontaneously by postoperative day three (POD 3). Case 2: a 75-year-old man (ASA III) underwent an uncomplicated right lower lobectomy for a clinical stage IA3 NSCLC. Case 1 and 2 were discharged on POD 5 and 4, respectively., Conclusions: From what emerged in our small series, U-RATS with the Da Vinci Xi surgical system might be considered a safe, reliable, and effective alternative to other MIS techniques. Larger prospective studies are required to validate these findings., (© 2022 John Wiley & Sons Ltd.)

Background: Thoracotomy, video-assisted thoracoscopic surgery (VATS) and robotic assisted thoracoscopic surgery (RATS)-lobectomy are widely accepted procedures for the surgical treatment of clinical (c)stage I non- small cell lung cancer (NSCLC). In the current literature which procedure gives more benefits is still debated. We present a comparison between these three procedures in term of advantages and postoperative outcomes., Methods: A multicentric study about 259 lobectomies from 2013 to 2019: 128 patients underwent TL, 96 VATS and 35 RATS. Different variables were retrospectively analyzed among these three cohorts of patients with diagnosis of cStage I NSCLC., Results: Rate of major complications comparable in VATS, RATS and TL; Advantages for RATS in minor complications (TL 34.4% vs. VATS 18.75% vs. RATS 8.57%. P=0.0015), postoperative days in Intensive Care Unit, days to chest tube removal, length of postoperative hospitalization (P<0.0001) and number of lymph nodes dissected (P=0.0257). Operating times are shorter in VATS than RATS (P<0.05). Pain (NRS Scale) is comparable., Conclusions: TL remains the conventional approach for stage II-IIIA(N2) NSCLC. RATS showed great advantages, but its higher operating time and costs, mostly, today don't justify its adoption as gold standard for the surgical treatment of cStage I NSCLC, instead of VATS.

Aim: The present study aimed to demonstrate that computed tomography-guided transthoracic needle biopsy (TTNB) is a safe procedure that gives a more accurate pre-operative tissue diagnosis for peripheral lung nodules than transthoracic needle aspiration, obtaining suitable samples for molecular test in lung adenocarcinomas. Patients & methods: Between December 2016 and March 2018 at Thoracic Surgery Department of the University of Palermo - Policlinico Paolo Giaccone hospital, TTNB was performed in 42 patients with computed tomography-detected peripheral lung nodules >10 mm, using 16-18-Gauge Tru-Cut needles. Results: With TTNB, we have estimated an accuracy for tissue diagnosis of 97.6%. At the molecular test, EGFR overexpression and ALK mutation resulted positive for 12/23 patients with lung adenocarcinoma. Conclusion: TTNB has showed a low rate of complications and it is adoptable as standard diagnostic procedure for peripheral lung nodules.

Background: Case report of a 78-year-old male who came to our observation for a growing pulmonary mass of the left upper lobe without a pre-operative diagnosis. Post-operative histopathology revealed an intrapulmonary Solitary Fibrous Tumour (SFT) of the lung., Case Report: The pulmonary lesion was an ovoid mass centrally located in the left upper lobe; it had been known and stable in size for two years; the last Chest Computed Tomography (CT) Scan highlighted a marked increase in maximum diameter (35 versus 22 mm) with contrast enhancement. In view of the growth of the lesion, the patient was referred for surgery after multidisciplinary team evaluation, although a pre-operative diagnosis had not been reached. The patient underwent Video-Assisted Thoracic Surgery (VATS) left upper lobectomy by a biportal approach. The pulmonary nodule consisted of a proliferation of bland-looking spindle cells intermingled with fibrotic stroma and alternating sclerotic and cellular areas. At immunohistochemistry, the spindle cells expressed CD34, bcl2 and CD99. A final diagnosis of intrapulmonary SFT was reached. The 36-month follow-up was negative for relapses., Conclusions: Primary intrapulmonary SFTs are extremely rare neoplasms, generally with benign biological behaviour; surgical resection is safe and essential in order to be curative and can be achieved by a minimally invasive approach. Pre-operative diagnosis is challenging, due to aspecific clinical and radiological features., Key Words: Lung, Solitary Fibrous Tumour, Video-Assisted Thoracic Surgery Lobectomy.

Introduction: Prolonged air leak (PAL) is one of the most common postoperative complications after lung surgery. It is associated with increased significant morbidity, lower quality of life, longer hospital stay and higher hospital costs. Since its great clinical and economic burden, it is important to establish the feasibility and the effectiveness of the routinary preventive use of a fibrin sealant in order to reduce the incidence of prolonged air leaks., Patients and Methods: This is a randomized study on 189 adult patients - 118 men (62.4%) and 71 women (37.6%) aged from 39 to 87 y.o. (mean age 68.3 y.o.) - who underwent lung surgery (lobectomy or bilobectomy) with intraoperatory detection of air leakage, from January 2013 to December 2017, at Department of Thoracic Surgery in "Ospedale Maggiore Carlo Alberto Pizzardi" (Bologna, Italy) and Department of Thoracic Surgery in "Paolo Giaccone" Teaching Hospital (Palermo, Italy). Patients were randomly assigned to the "Glue" arm (90 patients) or the "Control" group (99 patients). We only used stapler or manual suture to achieve aerostasis. In addition, we used a fibrin sealant ("glue") to cover the suture line on patients in the "Glue" arm. The primary endpoints were incidence of prolonged air leaks, days with chest tube and mean hospital stay., Results: In the "Glue" arm we experienced only 1 prolonged air leak (1.1%), while in the "Control" group there were 8 leaks (8.1%). Patients kept chest tube for average 4.15 days in the "Glue" arm and 4.45 days in the "Control" group. The mean hospital stay was average 7.4 days for the "Glue" arm, while 9.1 days in the "Control" group., Conclusions: According to our experience it seems that the routinary preventive use of a fibrin sealant results in a lower incidence of prolonged air leaks, a shorter hospital stay with lower hospital costs, representing a cost-effective, feasible and effective system to decrease morbility and mortality among surgical patients.

Primary leiomyosarcomas of the lung are tumors. We report a case of 49-year old female with history of cough, breathless at rest, right sided chest pain. Chest CT showed a huge (16 cm) mediastinal mass located on the right mediastinum encasing the right main pulmonary artery and infiltrating the main right bronchus and pericardium. The tumor was resected with combined pericardiectomy and pnemonectomy via hemiclamshell incision. This surgical access provided an adequate exposure of the chest "blind zones" and it allowed a radical and safe surgical resection of lung, pleura, pericardium and diaphragm. The final diagnosis showed a low grade differentiation leiomyosarcoma.

Aim: Thoracoscopic lobectomy is superior to thoracotomy, but the evidence for this assumption is low. We present a comparison between thoracotomy and thoracoscopy in term of postoperative complications, mortality, postoperative pain, hospital stay and quality of life., Patients and Methods: This is a retrospective analysis of 224 lobectomies in 24-months. 128 patients (57.1%) were operated by thoracotomy; 96 patients (42.9%) by videothoracoscopy., Results: Major complications were observed in 4/128 (3.1%) in thoracotomy group and in 1/96 (1%) in thoracoscopy. Minor complications were observed in 38/128 patients (29.7%) in the thoracotomy, and in 16/96 (16.7%) thoracoscopy. Thoracoscopy patients had a shorter hospital stay., Conclusion: Our study shows an advantage of thoracoscopy over thoracotomy but further studies are needed.

The choroid is the most common site for intraocular metastatic di sease. Orbital metastasis as metastatic site of lung adenocarcinoma is very rare and in literature a very exiguous number of cases is present. This is a case report of a woman with history of lung adenocarcinoma and, after surgery, detection of a choroidal mass described as lung metastasis, responding to Gefinitib therapy. However a biopsy was not performed. After two years there was a great dimension decrement of the lung metastasis but she is still suffering from recurrent pleural effusion, with pleural thickenings biopsied and diagnosed as recurrences of disease.

Introduction: The ideal surgical approach for pulmonary metastasectomy remains controversial. Thoracoscopic surgery may offer advantages in quality of life outcomes, with equivalent oncologic long-term results. This study aimed to demonstrate the validity of video-assisted thoracoscopic surgery (VATS) in the treatment of lung metastases., Methods: In all 224 patients who underwent 300 VATS metastasectomies from January 2000 to December 2013 were retrospectively reviewed. Sixty-nine patients underwent major resection (68 thoracoscopic lobectomies and one pneumonectomy) and 155 patients underwent a wedge resection/segmentectomy. Complete curative pulmonary resections were performed in 219 (97%) cases. The Kaplan-Meier method was used to estimate survival curves. Univariate and subsequent multivariate Cox model regression were performed to identify independent factors of overall survival., Results: One hundred eighty-six patients developed lung metastases from epithelial tumors, 28 from sarcomas, seven from melanomas, and three from germ cell tumors. The final pathological examination revealed no cases of R1 disease. After a mean follow-up of 40 months, 118 patients (53%) had died. According to a multivariate analysis, a better prognosis was not observed for patients with a particular histological type; in addition, disease-free interval time, age, number of metastases, and type of surgery did not have any statistical influence on long-term survival., Conclusions: Thoracoscopic surgery is a safe and efficacious procedure, with a five-year overall survival that is equivalent to open surgery.

Hepatic artery aneurysm is an uncommon and potentially fatal form of vascular disease. We report the case of a 53-year-old man with an isolated, nontraumatic rupture of an aneurysm of a replaced left hepatic artery originating from the left gastric artery. This case is unusual because the ruptured aneurysm involved an hepatic artery with a rare vascular pattern., (© 2015 The Authors.)

Introduction: The ideal surgical treatment for pulmonary metastasectomy remains controversial. Minimally invasive surgery may offer advantages for quality of life outcomes, with equivalent oncologic long-term results. The purpose of our study was to confirm the validity of the thoracoscopic approach for pulmonary metastasectomy., Methods: We retrospectively reviewed 164 patients who underwent 212 lung metastasectomies from January 2000 to December 2010. Complete curative pulmonary resections were performed in 159 (96.95 %) cases; 126 patients developed lung metastases from epithelial tumors: 28 from sarcoma, 7 from melanoma, and 3 from germ cell tumors. The mean disease-free interval (DFI) was 38.75 months. Fifty-four patients underwent a major VATS resection (53 thoracoscopic lobectomies and 1 pneumonectomy), and 110 patients underwent a wedge resection/segmentectomy. Lymph node sampling was performed in 117 cases., Results: After a mean follow-up of 38 months, 87 patients (53 %) had died. All resection margins were tumor-free at final pathological examination. Multivariate analysis not confirmed in our series a better prognosis for patients with a particular histologic type and also DFI, age, number of metastases, and type of surgery did not statistically influence long-term survival., Conclusions: Thoracoscopic surgery is an acceptable procedure, safe and efficacious, with a 5-year overall survival that is equivalent to open surgery.

Background and Objectives: To verify the hypothesis that avoidance of routine splenectomy and distal pancreatectomy in a modified D-2 resection for gastric cancer can significantly lower the complications rate of this procedure in a population of Western patients., Methods: A series of 250 consecutive Italian patients suffering from localized, histology-proven gastric cancer was submitted to gastrectomy and extended D-2 lymphadenectomy for treatment of their disease during an 8-year period (1994-2002) at the European Institute of Oncology in Milano, Italy. Caudal pancreas and spleen were routinely preserved, unless the tumor was not closely adjacent to or directly invading these organs. Postoperative morbidity, overall mortality, and length of hospital stay were recorded., Results: One hundred forty patients underwent total gastrectomy and 110 a subtotal distal one; splenectomy was performed in 8 cases and spleno-pancreatectomy in 15. The postoperative morbidity rate was 18%, the mortality rate was 1.2% and 9 patients experienced re-operation. The median length of stay was 14.8 days., Conclusions: These results compete favorably with those reported after standard D-1 gastrectomy in Western patients series. D-2 gastrectomy with spleen and pancreas routine preservation can be considered a safe treatment for gastric cancer in Western patients, at least in experienced centers., ((c) 2006 Wiley-Liss, Inc.)