Journal and News Scan

Transcatheter aortic valve replacement (TAVR) has surpassed surgical aortic valve replacements in volume since TAVR is now approved for patients of all surgical risk categories. This article evaluated trainees and program directors to assess current training patterns and comfort levels regarding catheter-based interventions. A majority of trainees had a mean of 2.8 months on dedicated catheter-based rotations, although often serving as assistants. Only a minority of residents across the board felt comfortable performing these procedures (12 percent with dedicated rotations and 10 percent without). The authors highlight the increasing need for a more robust catheter-based intervention curriculum to aid with training the upcoming generation of cardiothoracic surgeons.

Button battery ingestion in children is associated with severe morbidity and mortality if not treated promptly, due to the coagulation necrosis that ensues. Formation of a tracheoesophageal fistula (TEF), due to tissue necrosis, is an exceedingly rare complication, albeit one that carries high mortality. This article reports on four cases of TEF, their presentation, perioperative management, the surgical treatment employed, and follow-up. The authors discuss the use of esophagectomy with cervical fistula, repair of the trachea with aortic homograft, and the use of latissimus dorsi pedicled interposition flaps to cover and reinforce large tracheobronchial defects. The authors also discuss their technique and rationale for using aortic homograft due to its stiffer mechanical properties compared to bovine or autologous pericardium, thus, theoretically, applying less stress to suture lines.

Surgical treatment of pleural mesothelioma remains challenging and carries high morbidity, especially in patients who develop post operative empyema. This interesting article retrospectively studied 400 patients of whom 50 developed postoperative empyema. Extrapleural pneumonectomy (EPP) was found to be the only risk factor associated with development of empyema, with an odds ratio of 2.8 after controlling for confounding factors. Of note, survival was significantly worse in patients who developed empyema compared to those who did not.

The aim of this study was to demonstrate the ability of the Versius Surgical System to successfully and safely complete a range of thoracic procedures aligned with phase 2a of the (Development) of the Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework for surgical innovation. 

This prospective study included the first 30 consecutive patients who underwent robotic surgery with Versius by two surgeons without prior robotic experience between 1 April 2023 and 30 December2023 (25 lung resections [i.e., wedge, segmentectomy, lobectomy] and 5 thymectomies). There were no specific predetermined selection criteria for each case. The primary outcome was safe completion of the procedure without unplanned conversion. Secondary outcomes included intraoperative and postoperative complications, intraoperative device-related outcomes, and pathology results. 

Twenty-eight cases (93.3 percent) were completed without conversion. Both conversions were to thoracoscopy, one due to a console alarm and the other due to a pulmonary artery bleeding. In lung resections, the median console time was 103 (90–129) minutes. Five patients (20 percent) experienced postoperative complications, the most frequent was persistent air leak (16 percent). The median length –of stay was 3 (2–4) days. Neither readmissions nor mortality was observed. In thymectomies, no intraoperative or postoperative complications, readmissions, reinterventions or mortality were observed. The median console time was 77 (75–89) minutes and the median length of stay was 1 (1–1) day. 

This phase 2a IDEAL-D study confirms lung resections and thymectomies are feasible with the use of Versius system, laying the foundation for larger phase 2b and 3 clinical studies within the IDEAL-D framework.