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Abstract: Introduction: VATS wedge resection can require conversion to thoracotomy when pulmonary lesions cannot be identified. Hybrid operating rooms (HORs) provide real‐time image acquisition capabilities allowing the intraoperative placement of markers to facilitate the removal of non‐palpable nodules during VATS. Objectives: To present our workflow based on the alternative use of two different markers according to the location of the lung lesion and report our initial results. Methods: All consecutive patients with non‐palpable lesions requiring VATS wedge resection underwent localization of the targets in HOR. Lesions were considered non‐palpable if they were small (<1 cm), deep (>1 cm from surface), subsolid, or located within a dystrophic area. Anesthetized patients were placed in lateral decubitus. Cone‐beam CT (CBCT) was performed, and the needle trajectory was planned using Syngo iGuide Needle Guidance. Metal hook‐wire or coil was placed, according to our workflow, close to the lesion and their position was verified by CBCT or fluoroscopy. Results: Eleven VATS wedge resections were performed in 10 patients with 12 non‐palpable lesions. The localization was performed with seven hook‐wires and four coils in 30 minutes (range 17‐56 minutes). The median estimated total effective dose was 11.6 mSv (range 1.9‐24.7 mSv). Eleven lesions were removed by VATS, and one deep nodule required a thoracotomy. No complications were observed. Conclusions: Our experience confirms that HOR is suitable for simultaneous localization and VATS resection of ‘difficult’ pulmonary lesions. A versatile approach, using different devices, seems advisable for the removal of targets in every clinical scenario, reducing the VATS conversion rate. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Early diagnosis of invasive bronchopulmonary aspergillosis (IBPA) is difficult, so the mortality rate is high. Objective: To discuss the clinical features of IBPA. Methods: We retrospectively analyzed the clinical features, imaging findings, laboratory test, diagnosis and treatment of 115 patients with IBPA diagnosed from October 2004 to June 2013 in Zhongshan Hospital, Fudan University. Results: The main clinical manifestations were cough in 58 patients (50.4%), expectoration in 37 patients (32.2%), fever in 18 patients (15.7%), shortness of breath in 26 patients (22.6%), hemoptysis in 26 patients (22.6%) and chest pain in 7 patients (6.0%). The main CT findings were nodules in 35 patients (30.4%), consolidation shadows or patchy shadows in 62 patients (53.9%) and cavity in 14 patients (12.2%). Percutaneous pulmonary biopsy was conducted in 25 patients (21.7%), TBLB in 58 patients (50.4%) and thoracoscopic surgery in 32 patients (27.8%). The positive rate of GM test was 73.5% (72/98). Thirty patients who received lobectomy were followed up for 1‐3 years. Fifty‐five patients who received monotherapy with antifungal agents were followed up for 1‐3 years, and 12 patients were healed. The lesions for 23 patients were obviously absorbed, 10 patients had aggravation and two patients died. Conclusions: The clinical manifestations of IBPA were unspecific. The main symptoms were cough and expectorate. Patients with different immunologic function had different imaging findings. The halo sign and new moon sign for diagnosis was not as common as reported. Interventional therapy under bronchoscope is very important for patients with ATB. [ABSTRACT FROM AUTHOR]

Abstract: Herein, we described a novel method as the use of AcuBlade robotic microsurgery system to manage idiopathic subglottic stenosis in a 73‐y‐old lady. Compared to traditional CO2 lasers, AcuBlade facilitated the scar resection by the generation of different shape of beams (straight, curved, or disk). The same setting used for phonomicrosurgery (1‐mm beam length, power of 10 W and pulse duration of 0.05‐s) allowed to obtain fast, long, and uniform cuts. In addition, the reduction of the number of laser passes over the same area prevented injury of adjacent tissue and thus reduced the risk of recurrence. [ABSTRACT FROM AUTHOR]

Abstract: Contralateral tension pneumothorax during one‐lung ventilation is a rare but catastrophic surgical complication. A 72‐year‐old Japanese male with lung cancer underwent right upper lobectomy with video‐assisted thoracoscopic surgery. Despite use of various methods for maintaining oxygenation during one‐lung ventilation, percutaneous oxygen saturation was unstable from the start of surgery and suddenly decreased with a drop in blood pressure. An intraoperative chest X‐ray revealed a tension pneumothorax of the dependent lung. Insertion of a chest drain saved the patient's life. This case suggests that a contralateral tension pneumothorax should be considered as a possible cause when adequate oxygenation cannot be maintained during one‐lung ventilation. [ABSTRACT FROM AUTHOR]

Background and Aims The solitary pulmonary nodule ( SPN) is a common clinical problem usually detected incidentally during screening tests for lung cancer. Video-assisted thoracoscopic surgery ( VATS) is performed for diagnosing SPNs when there are technical difficulties with transthoracic needle aspiration biopsy or bronchoscopic biopsy, inconclusive biopsy results, or when there is a high suspicion of malignancy. This study aimed to identify factors that can reduce unnecessary VATS for the diagnosis of SPNs. Methods We retrospectively analysed patients with SPNs ( n = 107) who had undergone diagnostic VATS at Seoul National University Hospital from January 2007 to December 2008. Clinical and radiological parameters were evaluated to compare benign and malignant SPNs. Results Benign SPNs were diagnosed in 31 patients (29.0%). The most common reason for patients to undergo a diagnostic VATS was a history of malignancy. The most common histological findings in patients with benign SPNs were non-specific inflammatory lesions (29.0%) and tuberculosis (16.1%). The presence of respiratory symptoms was significantly associated with benign diseases [ P = 0.004, odds ratio ( OR) 0.189, 95% confidence interval ( CI) 0.060-0.590], and part-solid nodules were significantly related to malignancy ( P = 0.026, OR 6.34, 95% CI 1.248-32.169). Conclusion Approximately 30% of SPNs resected by VATS were benign. Although we did not identify a definite factor for predicting benign disease or malignancy, the presence of respiratory symptoms was related to benign disease, and part-solid nodules were associated with malignancy. [ABSTRACT FROM AUTHOR]

With the progress of antibiotic therapy, the mortality of lung abscess has been improved, and surgical intervention has declined. However, surgery is still required in selected cases that are intractable to antibiotic treatment. Video-assisted thoracoscopic surgery ( VATS) is beneficial for treatment and/or diagnosis of pulmonary disease as it provides a less invasive surgical technique and reduces prolongation of post-operative recovery. However, the indication of VATS lobectomy for lung abscess is controversial as a result of particular complications, i.e. wet lung, intrapleural adhesion and ease of bleeding. We herein report a rare combination of lung abscess and osteomyelitis of mandible resulting from the same pathogen successfully treated with VATS lobectomy. We propose VATS lobectomy for lung abscess. This procedure might be the best treatment candidate for selected cases of lung abscess. [ABSTRACT FROM AUTHOR]

Background Hyperinflation of the native lung ( NLH) is a known complication to single-lung transplantation for emphysema. The hyperinflation can lead to compression of the graft and cause respiratory failure. Endobronchial valves have been used to block airflow in specific parts of the native lung, reducing the native lung volume and relieving the graft. Objective We report short-term follow-up and safety from 14 single-lung transplant patients with NLH treated with bronchoscopic lung volume reduction using endobronchial valves. Methods Retrospective clinical information related to endobronchial valve treatment was obtained from four centres. All patients were treated with IBVTM Valve System ( Spiration, Olympus Respiratory America, Redmond, WA, USA). All patients had evidence of severe NLH with mediastinal displacement. Results A total of 74 IBV valves were placed in 14 patients, with an average of 5.3 (range 2-10). Five patients had two procedures with staged treatment. Eleven patients reported symptom relief, and nine had lung function improvements. There was a significant increase in forced expiratory volume in 1 s of 9% ( P = 0.013) and forced vital capacity of 15% ( P = 0.034) within the first months after treatment. There were no reported device-related adverse events nor reports of migration. Two patients had pneumothorax. One patient had pneumonia in the location of the valve placement, and another had infection within days. Three other patients were hospitalised with infection 2 months after treatment. Conclusions Treating NLH with IBV endobronchial valves leads to clinical improvement in the majority of patients, and the treatment has an acceptable safety. [ABSTRACT FROM AUTHOR]

Headscarf needle aspiration is a rare event, especially in Middle and Western European countries. Here, we report the case of a 37-year-old Austrian woman of Turkish origin who accidentally aspirated a turban pin. Repeated bronchoscopy was not successful in removing the aspirated foreign body, which extended past the right middle lobe to the interlobar fissure. The needle was finally removed by video-assisted thoracoscopic surgery. [ABSTRACT FROM AUTHOR]