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Introduction: Uniportal video-assisted thoracoscopic surgery (uVATS) is becoming popular for major lung resections, even for more complex procedures. The technique initially described for minor procedures seems more difficult to reproduce and has a longer learning curve. This review aims to describe the evolution from multiportal to uVATS and to explore its feasibility and reproducibility by identifying its drawbacks and limitations., Methods: Research from PubMed was obtained with the terms [uniportal] AND [surgery] OR [single-port] AND [thoracic surgery] OR [VATS]. Papers concerning pediatric cases and non-English papers were excluded. Individual case reports were also excluded., Discussion: uVATS seems to be widely adopted and performed for minor procedures. The applicability of uVATS for different indications is discussed, even though practically all thoracic surgical interventions can be performed through a single incision., Conclusions: The transition from conventional three-port VATS to uVATS is described in this paper. An increasing number of thoracic surgeons worldwide have adopted this approach, even for major complex anatomical lung resections. Regarding the performance of minor thoracic interventions, we believe this technique is easily reproducible with a short learning curve because the instruments do not cross each other, and intraoperative movements remain intuitive. It is therefore a feasible, safe, and efficacious technique. For these reasons, we believe uVATS should be offered to all patients undergoing minor thoracoscopic procedures.

Background: Double coronary artery is a rare anomaly with just a few cases reported in the literature. This anomaly started being reported recently with the wide use of coronary angiography. Before the advent of advanced imaging and catheterization facilities most of the available data came from the work of anatomists. Two patients were recently operated in our department. In the first patient the preoperative coronary angiography showed two right coronary arteries. In the second patient a double ostium of the right coronary artery was encountered intraoperatively. We wanted to know the incidence of this anomaly and the available data in the literature., Methods: A PubMed research was conducted by using the term 'double right coronary artery'. More than 50 case reports and small case series were identified., Results: The review of the literature revealed a lot of controversy and debate. When using the term 'double right coronary artery' authors do not always refer to the same entity. Different definitions and classifications have proposed without, however, gaining wide acceptance. In fact, there is a lot of confusion in the literature and cases that are rather common are presented as being 'extremely rare'., Conclusions: Even though the real incidence could be over or underestimated due to variability in coronary angiography interpretation, clinicians must be aware of this entity in order to avoid troubleshooting during percutaneous coronary interventions and cardiac surgery. There is need for a close collaboration between interventional cardiologists, anatomists and cardiac surgeons in order to standardize the nomenclature.

Background: There are studies showing the utility of the 18-fluorodeoxyglucose positron emission tomography ( 18 FDG PET) scan in the management of patients with thymic epithelial tumors. It seems to be a correlation between the standard uptake value (SUVmax) of thymic epithelial tumors and the histological type and the stage. This study aims to use the ratio of the SUVmax of the lesion to the SUVmax of the adjacent mediastinal tissues in order to guide the choice of the surgical access., Methods: All patients who presented an anterior mediastinal lesion with a high suspicion of being of thymic origin were included in a prospective database. A ratio inferior to 1 could predict a benign nature and less aggressive behavior, and a minimally invasive approach was performed. A ratio superior to 1 suggested a malignant and aggressive behavior, and a median sternotomy (or a thoracotomy) was performed., Results: There were 15 male (mean age 44.6 ± 16.26 years, range 25-73) and 15 female patients (mean age 50.1 ± 16.94 years, range 25-76). When the ratio is inferior to 1, it predicts benign disease in 80% of cases. When it is superior to 1, it predicts in half of cases advanced histological types (high risk thymomas and thymic carcinomas). On the contrary, it can quite accurately predict advanced Masaoka-Koga stages., Conclusions: The protocol of this study is in accordance with the current literature showing the utility of 18 FDG PET scan in the treatment of thymic epithelial tumors. This study goes one step further since the choice of surgical access is based on the SUVmax values. The ratio SUVmax of the lesion/SUVmax of the mediastinal tissues could be a new marker, more pertinent than absolute SUVmax values., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Moraitis, Agrafiotis, Skoura, Kalkanis, Moraitis, Tomos, Liakakos and Angouras.)

Anterior mediastinal masses are relatively uncommon and include a wide variety of lesions. Lymphomas account for 25% of anterior mediastinal masses. Lymphomas and other haematological malignancies are associated with pericardial effusion. There are also cases where a cardiac tamponade occurred. The aim of the case reported herein is to discuss the surgical approach and particularly the mediastinal debulking as an adjunct to systematic treatment for haematological diseases presenting as an anterior mediastinal mass responsible for a cardiac tamponade.

The familial occurrence of thymic pathology, even though rare, is widely reported in the literature and mainly concerns cases of familial autoimmune myasthenia gravis. Other less frequent cases of familial occurrence of thymoma, thymic carcinoid and thymic hyperplasia have been described. It seems that the familial occurrence is poorly recorded and thus its prevalence is underestimated. We report two families whose members presented different forms of thymic pathology and discuss the necessity of screening programs in family members of patients presenting a thymic lesion.

Breast reconstruction is a very popular surgical intervention performed either for cosmetic reasons or after oncological resections. Even though silicone is considered to be an inert material, there are side effects that have been reported, such as silicone lymphadenopathy. In the case reported herein, a silicone lymphadenopathy of the internal mammary and the anterior mediastinal lymph nodes were revealed after a thymectomy for autoimmune myasthenia gravis. Silicone lymphadenopathy should always be part of the differential diagnosis of enlarged lymph nodes, in patients with previous cosmetic or oncoplastic surgery with the use of silicone gel breast implants. Special attention should be paid in case of previous breast cancer in order to rule out metastasis.

Myxomas are the most common benign cardiac tumors and are located more frequently in the left atrium. In the literature there are cases describing the coexistence of thymic tumors and cardiac myxomas. In the case reported herein, during the resection of a cardiac myxoma, an enlarged thymus gland was encountered and resected. The histological exam revealed a thymic hyperplasia. The aim of this case study is to assess the need of conducting further studies in order to identify a common histological pathway between thymic lesions and cardiac myxomas. The diagnosis of a cardiac myxoma could justify a further workup of the anterior mediastinum in order not to overlook a lesion of thymic origin.