Although Brazil has a reasonable number of general thoracic surgeons, inequalities in their distribution through the country arise as one of the most concerning problems of the speciality. The results of this study show that leadership actions and consistent government policies are required to improve work conditions and provide efficient workforce planning.

Background/Aims: Laparoscopy is a widespread surgical approach for many urological conditions. Achieving prof-ciency in laparoscopic surgery requires considerable effort due to the steep learning curve. Several residency programs include standardized laparoscopic training periods in their curricula. Our aim was to systematically analyze the evidence on the current status of training in laparoscopy in different residency programs in urology. Methods: We performed a systematic review of PubMed/Medline and the Cochrane library, in February 2018, according to the Preferred Reporting Items for the Systematic Review and Meta-Analyses Statement. Identified reports were reviewed according to the previously defined inclusion criteria. Eight publications, comprising a total of 985 urology residents, were selected for inclusion in this analysis. Results: There was a wide variation between training programs in terms of exposure to laparoscopy. Most residents considered that training in lap-aroscopy was inadequate during residency and had a low degree of confidence in independently performing laparo-scopic procedures by the end of the residency. Only North American residents reported high degrees of confidence in the possibility of performing laparoscopic procedures in the uture, whereas the remaining residents, namely from European countries, reported considerably lower degrees of confidence. Conclusion: There were considerable differences between national urology residency programs in terms of exposure to laparoscopy. Most residents would prefer higher exposure to laparoscopy throughout their residencies.

For years cervical mediastinoscopy was the main and only way to access the mediastinal status on lung cancer, but on the last decade new technologies had evolved either imaging, endoscopic or surgical procedures. Each one can give you very good results, but still have a different degree of certainty detecting anatomical extent of disease. Based on some published data and on our experience, we will address the use of video-assisted mediastinal lymphadenectomy (VAMLA) and trans-cervical extended maximal lymphadenectomy (TEMLA), named by Dr. Rami Porta as supermediastinoscopies, show procedures differences and where do we fit them on our practice.

Objectives: This study aims to evaluate the impact of using three predictive models of lung nodule malignancy in a population of patients at high-risk for neoplasia according to previous analysis by physicians, as well as evaluate the clinical and radiological malignancy-predictors of the images. Material and Methods: This is a retrospective cohort study, with 135 patients, undergone surgical in the period from 01/07/2013 to 10/05/2016. The study included nodules with dimensions between 5mm and 30mm, excluding multiple nodules, alveolar consolidation, pleural effusion, and lymph node enlargement. The main variables analyzed were age, sex, smoking history, extrathoracic cancer, diameter, location, and presence of spiculation. The calculation of the area under the ROC curve assessed the accuracy of each prediction model. Results: The study analyzed 135 individuals, of which 96 (71.1%) had malignant nodules. The areas under the ROC curves for each prediction model were: Swensen 0.657; Brock 0.662; and Herder 0.633. The models Swensen, Brock, and Herder presented positive predictive values in high-risk patients, corresponding to 83.3%, 81.8%, and 82.9%, respectively. Patients with the intermediate and low-risk presented a high malignant nodule rate, ranging from 69.3-72.5% and 42.8-52.6%, respectively. Conclusion: None of the three quantitative models analyzed in this study was considered satisfactory (AUC> 0.7) and should be used with caution after specialized evaluation to avoid underestimation of the risk of neoplasia. The pretest calculations might not contemplate other factors than those predicted in the regressions, that could present a role in the clinical decision of resection.