Objective: This international multicenter study by the Upper GI International Robotic Association aimed to gain insight in current techniques and outcomes of RAMIE worldwide. Background: Current evidence for RAMIE originates from single-center studies, which may not be generalizable to the international multicenter experience. Methods: Twenty centers from Europe, Asia, North-America, and South-America participated from 2016 to 2019. Main endpoints included the surgical techniques, clinical outcomes, and early oncological results of ramie. Results: A total of 856 patients undergoing transthoracic RAMIE were included. Robotic surgery was applied for both the thoracic and abdominal phase (45%), only the thoracic phase (49%), or only the abdominal phase (6%). In most cases, the mediastinal lymphadenectomy included the low paraesophageal nodes (n=815, 95%), subcarinal nodes (n = 774, 90%), and paratracheal nodes (n = 537, 63%). When paratracheal lymphadenectomy was performed during an Ivor Lewis or a McKeown RAMIE procedure, recurrent laryngeal nerve injury occurred in 3% and 11% of patients, respectively. Circular stapled (52%), hand-sewn (30%), and linear stapled (18%) anastomotic techniques were used. In Ivor Lewis RAMIE, robot-assisted hand-sewing showed the highest anastomotic leakage rate (33%), while lower rates were observed with circular stapling (17%) and linear stapling (15%). In McKeown RAMIE, a hand-sewn anastomotic technique showed the highest leakage rate (27%), followed by linear stapling (18%) and circular stapling (6%). Conclusion: This study is the first to provide an overview of the current techniques and outcomes of transthoracic RAMIE worldwide. Although these results indicate high quality of the procedure, the optimal approach should be further defined.

Video-assisted thoracic surgery (VATS) requires preoperative computed tomography (CT)-guided localization of small pulmonary nodules or ground glass opacities (GGOs). However, this traditional twostage approach is not devoid of potential complications, including wire dislodgement, pneumothorax, and/ or hemothorax. With the advent of hybrid operating rooms (HORs), simultaneous single-stage localization and removal of such lesions has become possible. Here, we review the technical developments and the stateof-the-art in the field of intraoperative CT-guided localization and resection of small pulmonary nodules performed within a HOR.

Managing the airway of patients with critical tracheal stenosis remains a formidable challenge to surgeons and anesthiologists. Various methods for controlling the airway have been established to solve this problem. This study describes the critical tracheal stenosis is managed by dilating and coring technique under direct vision with a rigid bronchoscope. From 2001 to 2003, 34 patients (23 males/11 females) with critical tracheal stenosis (>90%) underwent 37 surgical interventions. The etiologies included 8 cases of post-intubation, 7 cases of post-tracheostomy, 5 cases of post-anastomotic, 14 cases of endotracheal tumor (4 primary, 10 secondary), and 3 cases (1 tuberculosis, 1 laser burn, and 1 idiopathic) of other etiologies. All procedures could achieve airway control with rigid bronchoscope. Other endoscopic procedures (laser, and stent placement) were required to achieve a patent airway and seven patients received airway reconstruction as a definite procedure. Rigid bronchoscopy could provide good results for controlling airway in patients with critical trachea stenosis.