Anna Lucia Urgese

Ospedale Vito Fazzi

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Tips and tricks in video-assisted thoracoscopic surgery lobectomy

Future Oncology (2016)

Gaetano Di Rienzo Corrado Surrente Camillo Lopez Giovanna Imbriglio Gaetano Greco

In 2012, open procedures represented 63% of the total number of lobectomies performed in our unit; in 2015, video-assisted thoracoscopic surgery (VATS) lobectomy numbers increased up to 66% of the total number of lobectomies performed. When carrying out the procedures, we followed the guidelines presented by the International VATS Lobectomy Consensus Group regarding indications, contraindications, preoperative investigations and conversions. In view of 280 VATS major lung resections from May 2012 to May 2016, we describe some tips and tricks that can be useful in this surgical technique, from general principles to single operative procedures.

VATS lobectomy

Video-assisted thoracoscopic surgery

Thoracoscopy

10.2217/fon-2016-0333

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Modified transmanubrial osteomuscular sparing approach for resection of T1 vertebral tumor

European Journal of Cardio-Thoracic Surgery (2007)

Gaetano Di Rienzo Corrado Surrente Camillo Lopez Anna Lucia Urgese

We report a technical modification of the classic transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for the treatment of a T1 vertebral tumor. The goal of the surgical treatment for spinal tumors of the cervico-thoracic area is to excise the vertebral tumor, reconstruct the spinal column, and place an internal fixation device to achieve immediate stabilization. The procedure was necessary for treating a patient who presented with an invasion of T1 vertebral body by multiple myeloma with initial neurological symptoms of epidural spinal cord compression. This approach requires a multidisciplinary team, essentially composed by the thoracic surgeon, who performs the anatomical dissection of the cervico-thoracic area, and the neurosurgeon, who performs the vertebrectomy and placement of a titanium prosthesis (Harm's cage). The operation was successful; the follow-up 6 months after the surgical procedure is normal.

Vertebrectomy

Vertebral column

Spinal cord compression

Thoracic spine

10.1016/j.ejcts.2007.07.019

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Cervico-manubrio-toracotomia secondo Grünenwald.Nostra esperienza in 3 casi di tumori dello stretto toracico superiore

Camillo Lopez Corrado Surrente G. Greco Anna Lucia Urgese A Lacitignola

Tumors of the cervical-thoracic area can be treated by the Grunenwald approach, which consists of an L-shaped cervical-manubrialthoracotomy without section of the clavicle. We used this access in three different tumors of the cervical-thoracic inlet: a tumor of T1 vertebral body, a tumor of the left superior sulcus, and a rare tumor originating from the root T1 of the brachial plexus. The first patient was a 39-years-old man with a somatic fracture of T1 and tumor invasion of the residual vertebral body by multiple myeloma. The 2nd patient was a 61-years-old man with a squamous cell carcinoma of S1 left upper lobe, infiltrating the parietal pleura and the chest wall, in the anterior-lateral part of the 2nd intercostal space. The 3rd patient was a 35-years-old woman with a glomic tumor originating from the T1 root of the right brachial plexus. The only post-operative complication was a modest diaphragm elevation in the 3rd patient, completely disappeared after 3-4 months. The 2nd patient is dead one year after the operation for cerebral metastases. The other two patients are presently in good conditions, without signs of relapse. Is our opinion the Grunenwald technique is technique for the treatment of tumors of the cervical-thoracic area allows a safe visibility of the anatomical structures without the necessity of a clavicle section.

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F-1522-PORT VERSUS 3- AND 4-PORT-ACCESS IN VIDEO-ASSISTED THORACOSCOPIC LOBECTOMY: A THREE-YEAR EXPERIENCE WITH 249 PROCEDURES

Interactive Cardiovascular and Thoracic Surgery (2016)

Gaetano Di Rienzo Corrado Surrente Camillo Lopez Giovanna Imbriglio Gaetano Greco

Port (circuit theory)

Video-assisted thoracoscopic surgery

VATS lobectomy

10.1093/icvts/ivw260.150

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Tumori del mediastino

A Lacitignola Corrado Surrente Camillo Lopez G. Greco Anna Lucia Urgese

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Transmanubrial osteomuscular sparing approach: different indications

Interactive Cardiovascular and Thoracic Surgery (2010)

Gaetano Di Rienzo Corrado Surrente Camillo Lopez Anna Lucia Urgese

The surgery of the cervico-thoracic inlet is a challenge for the thoracic surgeon. Several authors have described different approaches - with different degrees of invasiveness - to this anatomical area. We used the transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for six patients with five different indications: 1) left anterior Pancoast tumor; 2) glomus tumor originating from the inferior trunk (C8-T1 roots) of the right brachial plexus; 3) T1 vertebral tumor; 4) right internal jugular chain, Pirogoff confluence and subclavian artery metastatic lymph nodes from thyroid carcinoma; 5) chondrosarcoma of the first left rib. The results have been satisfactory from a surgical point of view, considering that the approach gave a good exposure of the operative field (especially at the cervical level), without cosmetic problems or functional limitations. In our experience, the transmanubrial osteomuscular sparing approach is a valid technique for the treatment of several kinds of tumors of the cervico-thoracic inlet, giving a good exposure of the operative field. In the case of anterior Pancoast tumors, the upper lobectomy may necessitate a further axillary thoracotomy, when fissural adherences are present.

Thoracotomy

Thoracic outlet

10.1510/icvts.2010.243238

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Citations (12)

Results of surgical resection for lung metastases

Uliano Morandi Alessandro Stefani Anna Lucia Urgese Ciro Ruggiero Marcello Paci

Surgical resection

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