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Optimal identification of the intersegmental plane can be challenging during thoracoscopic anatomical segmentectomy for lung cancer. We describe a simple new method of infrared-fluorescence-enhanced thoracoscopy with selected injection of indocyanine green into the bronchi not targeted for resection, which allows us to clearly identify the intersegmental plane in thoracoscopic segmentectomy.

Two patients with epithelioid haemangioendothelioma and one patient with multiple cavernous haemangiomas of the mediastinum, pharynx and larynx, are herein presented. Haemothorax as initial manifestation of the tumour was observed in one of them. Epithelioid haemangioendotheliomas were radically removed in both cases. Because of the absence of a well defined capsule and the huge extension, the cavernous mediastinal haemangioma was not resected. However the patient was successfully treated by administration of corticosteroids. Clinicopathologic characteristics of these benign forms of vascular tumours are discussed and treatment options are suggested.

Videothoracoscopy has reduced the number of thoracotomies performed. Thoracotomy can be limited to massive bleeding with hemodynamic instability, major air leak, radiologic evidence of mediastinal enlargement or diaphragmatic rupture, or major anterolateral flail chest.

The results suggest that Nd:YAG laser resection is safe and worthwhile in patients with multiple lesions and borderline pulmonary function.

Background: Mediastinal tumors often require surgical biopsy to achieve a precise and rapid diagnosis.However, subjects with mediastinal tumors may be unfit for general anesthesia, particularly when compression of major vessels or airways does occur. We tested the applicability in this setting of a minimalist (M) uniportal, video-assisted thoracic surgery (VATS) strategy carried out under locoregional anesthesia in awake patients (MVATS). Methods: We analyzed in a comparative fashion including propensity score matching, data from a prospectively collected database of patients who were offered surgical biopsy for mediastinal tumors through either MVATS or standard VATS. Tested outcome measures included feasibility, diagnostic yield, and morbidity. Results: A total of 24 procedures were performed through MVATS. Diagnostic yield was 100%. Median hospital stay and time interval to oncologic treatment were 2 days (IQR, 2-3 days) and 7 days (IQR, 5.5-11.5 days), respectively. At overall comparison (MVATS, N=24 vs. VATS, N=23), there was a significant difference in both frequency and severity of postoperative complication as measured by Clavien-Dindo classification (P<0.006). In a propensity score matched comparison (8 patients per group), grade 3 or 4 complications requiring aggressive management were found only in the general anesthesia group. Global time spent in the operating room was shorter in the MVATS group (P=0.05). Time interval to oncological treatment was the same between groups. Other differences were also found in SIRS score (P=0.05) and PaO 2 /FiO 2 (P=0.04) thus suggesting better adaption to perioperative stress. Conclusions: MVATS biopsy appears to be a reliable tool to optimize diagnostic assessment in patients with mediastinal tumors. It can offer high diagnostic accuracy due to large tissue samples, while reducing morbidity rate compared to the same operation under general anesthesia. More robust evaluation is needed to define the appropriateness of MVATS in this specific clinical setting.

Paraplegia after thoracic surgery is an uncommon complication, [1][2][3][4] and it is even more uncommon after surgery of the thoracic esophagus. Herein we describe 2 cases that occurred in our experience.Clinical summaries CASE 1. A 72-year-old man was admitted for the treatment of worsening dysphagia. Barium swallow and esophagogastroscopy revealed a mass 31 cm from the incisors, and the biopsy results showed squamous carcinoma. There was no evidence of locoregional spread or metastases at endosonography and computed tomographic scan. The examination revealed a 3.5-cm abdominal aortic aneurysm and diffuse signs of atherosclerosis. The patient underwent an intrathoracic esophagogastroplasty through a left thoracophrenolaparotomy. Tumor dissection necessitated the interruption of some vessels. No perigastric or mediastinal lymph nodes appeared to be involved. The early postoperative period was uneventful apart from a mild paresthesia of the lower limbs. After 24 hours he suddenly became unable to move his legs. Reflexes were totally absent below the T10-11 level. Multiorgan failure progressively developed and he died 7 days later. Postmortem examination showed a normal appearance of the anastomosis and of the tubulized stomach. An ischemic trait of the spinal cord at the T12-L1 level was also evident.CASE 2. A 58-year-old man was referred for treatment of a 5mm vegetating lesion that resulted in an infiltrating squamous cell carcinoma situated 27 cm from the upper incisors. Endosonography and computed tomographic scan did not show local infiltration or metastases. Esophagectomy was accomplished by blunt dissection, and tubulized stomach was anastomosed at the cervical level. No difficulties were found in gastric preparation and esophageal dissection. The early postoperative period was normal. After 38 hours, the patient began exhibiting a progressive sensory and motor deficit of the lower limbs originating at T6-T7. Magnetic resonance imaging showed an ischemic lesion of the spinal cord and excluded external compression. Apart from neurologic conditions, recovery was rapid. Despite continued medical and rehabilitative treatment, neurologic status was unchanged at 2 years.