Our early experience indicates that the combination of the MatrixRib system and Permacol patch for chest wall reconstruction is safe and feasible with promising results in terms of anatomical restoration of the chest wall mechanics, infection and pain.

Background: Minimally invasive robotic-assisted thoracic surgery is an increasingly popular platform for oncological thoracic resection. The aim of this study is to evaluate the feasibility of completely portal robotic lobectomy for patients with early non-small cell lung cancer (NSCLC), analysing the perioperative and midterm results. Methods: This is a single-institution retrospective cohort study of consecutive patients who underwent completely portal robotic lobectomy for early stage NSCLC over a 53-month period. Results: A total of 59 consecutive patients were included in this study. Median operative time was 155 min (range, 80-313 min). Conversion rate was 13.6%. Median intensive care/high dependency unit stay, chest tube duration and length of hospital stay were 1 day (range, 0-4 days), 2 days (range, 1-20 days) and 4 days (range, 2-30 days) respectively; 98.2% of patients achieved R0 resection. Overall, 23.7% had minor complications. There was no perioperative (30-day) mortality in this study. Final pathological staging distribution was 55.9% stage 1A, 23.7% stage 1B, 10.2% stage 2A and 10.2% stage 2B; 23% were upstaged after pathological staging. Median follow-up was 33 months (range, 3-70 months). The 3-year overall survival and recurrence-free survival were 86.2% (95% CI, 72.0-96.8) and 69% (95% CI, 56.1-81.9) respectively. The 3-year overall survival and recurrence free survival for stage 1 patients were 88.4% (95% CI, 77.4-99.4) and 75.6% (95% CI, 62.3-88.9) respectively. Conclusions: By clearly defining completely portal robotic lobectomy, it is possible to delivery promising perioperative and mid-term results for early stage primary lung cancer, even in a geographical location that has yet to assimilate this technology.

Surgical revascularization in patients with coronary artery disease and severe left ventricular dysfunction is a common practice and poses a surgical challenge. From September 2002 to May 2004, 50 patients (47 men and 3 women; mean age, 59 +/- 9 years) with a mean preoperative ejection fraction of 19.7% +/- 3.2% underwent surgical revascularization. The mean EuroSCORE was 7.2 +/- 3.4. Indications for surgery were congestive heart failure in 8 patients (16%), angina in 20 (40%), ventricular arrhythmias in 4 (8%), and critical left main stem disease in 12 (24%). Twenty-two patients (44%) had emergency surgery for critical anatomy and unstable symptoms. The number of grafts per patient was 3.7 +/- 0.8. Seventeen patients (34%) required intra-aortic balloon pump support, 16 (32%) needed pacing, and 48 (96%) had inotropic support postoperatively. Morbidity included re-operation for bleeding (2%), acute renal failure (10%), hemodialysis (4%), and fatal multiorgan failure (4%). Postoperative (4.9 +/- 3.7 months) 2-dimentional echocardiography was available in 18 patients of whom 11 (61%) showed improved left ventricular function (range, 5% to 45%). Thirty-day hospital mortality was 8%. These data indicate that surgical revascularization can be performed safely with acceptable hospital mortality in high-risk patients with severe left ventricular dysfunction.

Background There is a continuous debate on the appropriate diagnostic approach and surgical management of mycobacterial empyema, with widely varied diagnostic practices and surgical outcomes. The aim of this study is to highlight the diagnostic approach and clinical features of patients who required surgical intervention for mycobacterial empyema. Methods We performed a 5-year retrospective cohort study of all patients with mycobacterial empyema requiring surgery in a single institution from November 2009 to November 2014. Results Eighteen patients (15 males and 3 females, median age 48.5 years) required surgery. Seventeen patients required decortication via posterolateral thoracotomy and one patient underwent video-assisted thoracic surgery drainage and pleural debridement. Prolonged air leak was the commonest surgical complication (50%, n = 9). 94.4% (n = 17) had necrotizing granulomatous inflammation on histological examination. The sensitivity of mycobacterium smear and culture ranged between 12.5% and 75% for pleural tissue, sputum, and pleural fluid individually. The combination of all 3 samples increased the diagnostic yield to 100%. Conclusion With the implementation of pleural tissue culture at surgery, the novel combination of sputum, pleural fluid, and pleural tissue culture provides excellent diagnostic yield.

Kawasaki Medical School. Result: There were 135 eligible patients consisting of 91 male and 44 female, with mean age of 72.1 years (range, 43-87 years). Of 135 patients, 59 patients (43.7%) underwent adjuvant chemotherapy (platinum-based 15, UFT 44). Median followup period was 37.9 months (range 1.1-107.3 months). Overall survival of patients undergoing adjuvant chemotherapy was significantly better compared with that of patients with surgery alone (p¼0.032). There were no differences in recurrence-free survival between the two groups (p¼0.470). Patients who underwent adjuvant chemotherapy with platinum-based regimens survived significantly longer than patients who underwent surgery alone (p¼0.029). Overall survival of patients with platinum-based regimens tended to be better than that of patients with UFT. In a multivariate analysis including sex, age, histologic type, and tumor size, adjuvant chemotherapy was an independent prognostic factor for overall survival (p¼0.037). Conclusion: Adjuvant chemotherapy, especially with platinum-based regimen, provided a significant survival advantage for completely resected stage IB NSCLC.