No abstract

Simulation may provide a solution to acquire advanced skills in thoracic surgery, however to date there are no reports in the English literature about a perfused ex vivo model. We developed a low cost and hi fidelity model using an ex vivo in bloc heart and lung specimen from a swine. The swine was previously used in a non-thoracic experiment, so we extracted the lung and heart for this ex vivo based model to reduce animal use. The cost of the whole model is 70 USD and it can be reused many times changing the ex vivo tissue, so this model may help reduce the costs and animal use associated to this high complexity surgery. Model and video descriptionAs in a traditional uniportal human surgery, the model has a 4 cm utility incision. A 30° 10 mm camera was used in the posterior aspect of the incision. First, the left superior lobe is retracted posteriorly for hilum exposure. The anterior structure is the superior pulmonary vein. After opening the mediastinal pleura, dissection of the superior pulmonary vein is performed with blunt dissection and with an energy device. Section of the vein is made with a vascular endostapler. This exposes the main pulmonary artery. The next step is to identify the arterial branches for the superior lobe and divide them with a vascular stapler. To finalize, the upper lobe bronchus is dissected and then cut with a medium thickness endo-stapler.In the video, the setting of the surgeon and his assistant is shown in a comparable fashion to a human uniportal vats surgery (Figures 4,5).By pulmonary artery cannulation, the lung can be perfused with simulated blood allowing a more accurate vascular dissection.In order to demonstrate how well the system is perfused, a continuous bleeding secondary to an intentional arterial cut was shown. As this is a simulated blood perfused model it allows the operator to dissect the vessels in a more realistic setting (the vessels are not collapsed) and to see bleeding in case of any damage. ConclusionsA low cost and hi fidelity perfused uniportal VATS model was validated by an expert thoracic surgeon in uniportal VATS. This model may help reduce the costs and animal use associated to this high complexity surgery.

No abstract

Background: Thymic epithelial tumours are rare and highly heterogeneous. Reports from the United States suggest an overall incidence of 0.15 per 100,000/year. In contrast, the incidence of these tumours in Latin America is largely unknown and reports are scarce, somewhat limited to case reports.Methods: Herein, we report a series of 38 thymic tumours from a single institution, retrospectively incorporated into this study. Patient characteristics and outcomes including age, sex, stage, paraneoplastic syndromes, treatment regimens and the date of decease were obtained from medical records.Results: Most cases in our series were females and young age (<50 years old) and early stage by Masaoka-Koga or the Moran staging systems. Also, a 34% of patients had myasthenia gravis (MG). Next, we analysed overall survival rates in our series and found that the quality of surgery (R0, R1 or R2), MG status and staging (Masaoka-Koga, Moran or TNM) were prognostic factors. Finally, we compared our data to larger thymic tumour series.Conclusions: Overall, our study confirms complete surgical resection as the standard, most effective treatment for thymic epithelial tumours. Also, the Masaoka-Koga staging system remains as a reliable prognostic factor but also the Moran staging system should be considered for thymomas.

Background: Thymic epithelial tumors are rare and highly heterogeneous. Reports from the United States suggest an overall incidence of 0.15 per 100,000/year. In contrast, the incidence of these tumors in Latin America is largely unknown and reports are scarce, somewhat limited to case reports.Methods: Herein, we report a series of 38 thymic tumors from a single institution, retrospectively incorporated into this study. Patient characteristics and outcomes including age, sex, stage, paraneoplastic syndromes, treatment regimens and the date of decease were obtained from medical records.Results: Most cases in our series were females and young age (<50 years-old) and early stage by Masaoka-Koga or the Moran staging systems. Also, a 34% of patients had myasthenia gravis (MG). Next, we analyzed overall survival (OS) rates in our series and found that the quality of surgery (R0, R1 or R2), MG status, and staging (Masaoka-Koga or Moran) were prognostic factors. Finally, we compared our data to larger thymic tumor series.Conclusions: Overall, our study confirms complete surgical resection as the standard, most effective treatment for thymic epithelial tumors. Also, the Masaoka-Koga staging system remains as a reliable prognostic factor but also the Moran staging system should be considered for thymomas.