The ectopic or accessory liver lobe is an uncommon congenital anatomic abnormality. It is considered to be the outcome of an abnormal development of liver tissue during embryologic period. In some cases, it may be secondary to a trauma or a surgical operation. Literature reports only anecdotal cases; there are not series. The most common localization is the abdominal cavity, but very rarely it can also be found in the thoracic cavity. In most cases, preoperative correct diagnosis is very difficult because it is unlikely to consider this rare condition in course of differential diagnosis. Most cases are misdiagnosed, and patients undergo surgical intervention with suspect of lung lesion. Some times the intrathoracic accessory lobe is an intraoperative incidental finding. In this report, we present the case of a young female patient who underwent surgical treatment for a suspect pulmonary lesion that at histological examination resulted to be an intrathoracic accessory hepatic lobe.

ABSTRACT. A notion of rank for unitary representations of general linear groups over a locally compact, nondiscrete field is defined. Rank measures how singular a representation is, when restricted to the unipotent radical of a maximal parabolic subgroup. Irreducible representations of small rank are classified. It is shown how rank determines to a large extent the asymptotic behavior of matrix coefficients of the representations.

Although controlled studies have demonstrated the benefits of a minimally invasive approach for pulmonary lobectomy over thoracotomy, reports have also documented that significant complications can occur during thoracoscopic lobectomy and sometimes require planned or emergent conversion to open surgery. Several authors have identified and reported causes and implications of intraoperative conversion to thoracotomy using different types of classification. The aim of this single centre retrospective review is to evaluate how the reasons for conversion change with increased experience, dividing patients who were converted to thoracotomy during video-assisted thoracic surgery (VATS) lobectomy, between 2011 and 2017, in two groups: those treated during learning curve (LC group) and those treated after learning curve (ALC group). Our research suggests that the conversion rate, with increased skills, decreases but a variety of reasons for conversion persist. Of these, calcified, benign or malignant hilar adenopathy is the most frequent and represents the leading cause of conversion to open surgery due to complicated vascular dissection or vessel injury. It's strongly recommended, with increased confidence in performing VATS lobectomies, also to develop management strategies and techniques to prevent and control possible intraoperative adverse events.

Our 3D airway model in the management of airway stenosis is useful for procedural planning, rehearsal, and education. The fidelity level of the 3D model remains the main concern for its wider use in patient care. Thus, our impressions should be confirmed by future prospective studies.

Objective: A retrospective comparison between Nissen and Dor fundoplication after laparoscopic Heller myotomy for achalasia. Materials and Methods:From 1998 to 2004 a first group of 48 patients underwent Heller myotomy and Nissen fundoplication for idiopathic achalasia (H+N group). From 2004 to 2010 a second group of 40 patients underwent Heller myotomy followed by Dor fundoplication (H+D group). Some patients received a previous endoscopic treatment with pneumatic dilatation or endoscopic injection of botulinum toxin that provided them only a temporary clinical benefit. Changes in clinical and instrumental examinations from before to after surgery were evaluated in all patients. Clinical evaluation was carried out using a modified DeMeester symptom score system. Results: Dor fundoplication treatment reduced both dysphagia and regurgitation severity scores significantly more than Nissen fundoplication (p<0.0001). Indeed, the incidence of dysphagia was significantly higher in patients treated with floppy-Nissen than in those treated with Dor fundoplication: by defining dysphagia as a DeMeester score equal to 3 (arbitrary cut-off ), at the end of follow-up dysphagia occurred in 17.65% and 0% (p=0.037) of patients belonging to the H+N and H+D groups, respectively. Conclusion:Heller myotomy followed by Dor fundoplication is a safe and valuable treatment. The procedure showed a lower incidence of postoperative dysphagia versus Nissen fundoplication and a negligible incidence of postoperative GERD in a long-term postoperative follow-up. Bulgular: Dor fundoplikasyon tedavisi Nissen fundoplikasyondan daha fazla disfaji ve yetersizlik şiddet skorunu önemli (p<0.0001) ölçüde azaltmıştır. Sonunda, "disfajik" olarak değerlendirmenin DeMeester skorunun 3 (keyfi cut-off ) alındığı bir hastada, gerçekten de, Dor fundoplikasyon ile tedavi edilenlere göre floppy-Nissen ile tedavi edilen hastalarda disfaji insidansı oranı anlamlı derecede daha yük-sek bulunmuştur. Sırasıyla H+N ve H+D grubu grubundaki hastalarda %17.65 ve %0 (p=0.037) takip hastalığı (disfaji) oluşmuştur. Sonuç:Heller miyotomi-Dor fundoplikasyon güvenli ve değerli bir tedavi yöntemidir. Bu prosedür, postoperatif disfajiye karşı Nissen fundoplikasyon daha düşük bir insidans ve ihmal edilebilir bir oranda ameliyat sonrası uzun süreli bir takip de ameliyat sonrası GÖRH göstermiştir.

Morgagni hernia is a relatively uncommon congenital diaphragmatic hernia in which abdominal contents protrude into the chest through the foramen of Morgagni. It usually occurs on the right side of the chest but may occur on the left side or in the midline. In adults, it commonly presents with non-specific symptoms such as dyspnea, cough, gastroesophageal reflux disease and other. Surgical repair should be always performed to prevent the risk of hernia incarceration. Transthoracic approach has been proposed especially in cases with indeterminate, anterior pericardial masses. We believe that in adult obese patients with Morgagni hernia and voluminous hernial sac containing only omentum, the transthoracic approach can represent a valid alternative to transabdominal approach. The use of hybrid robotic thoracic surgery can be strongly recommended because it allows, through robotic instruments, to perform delicate surgical maneuvers in difficult to reach anatomical areas and, with the final extension of a port-site incision, to remove voluminous specimens from the thoracic cavity, avoiding the chest wall discomfort that follow the thoracotomy access.

Most intrathoracic goiters are located in the anterior mediastinum. Surgical resection is usually recommended in case of morbidity associated with the goiter's mass effect or for suspicion of malignancy difficult to diagnose without resection. Intrathoracic goiters are usually resected through a cervical approach, with sternotomy needed in selected cases. We report a case of antero mediastinal retrosternal goiter in old age patient undergoing surgical excision by combined cervical and hybrid robot-assisted approach. All steps of the thoracic procedure were completely performed using the da Vinci robot system with final extension of a port-site incision to extract the specimen. This approach provides more advantages than sternotomy regarding post operative clinical benefits and allows a more accurate surgical resection in the antero-superior mediastinum than conventional thoracoscopy.

No abstract