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Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 ​± ​1.7), followed by Live Patient only (4.3 ​± ​2.5), and KD only (2.6 ​± ​1.3). The mean confidence rating for residents with neither training opportunity was 1.4 ​± ​1.0. The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies. •Knowledge Donor provides hyper realistic training nearly replicating a live patient.•A unique perfusion-based platform with high-fidelity whole-body donors is the basis.•Knowledge Donor can revolutionize procedural training for medical learners.•Can be applied across any medical specialty with procedural learning.

Surgical intervention is essential for managing organizing thoracic empyema, but the efficacy of Video-Assisted Thoracic Surgery (VATS) in this disease stage remains debated. This study aims to compare the surgical outcomes of VATS versus open thoracotomy (OT) in the management of organizing thoracic empyema. This retrospective cohort study included 393 patients who underwent surgery for organizing thoracic empyema at Maharaj Nakorn Chiang Mai Hospital between January 1, 2012, and December 31, 2022, and were divided into VATS and OT groups. The primary outcomes were lung full expansion before discharge and at the 2-week follow-up. Secondary outcomes included intraoperative blood loss, duration of intensive care unit (ICU) stay, and postoperative pain scores. Data analysis was performed using multivariable regression analysis and propensity score matching. In the propensity-matched cohort (212 patients), patient characteristics were balanced between the two groups. VATS was associated with a higher likelihood of full lung expansion at discharge (risk ratio: 1.21; 95% CI: 1.01 to 1.45compared to OT. There were no significant differences in postoperative pain scores, or full lung expansion at 2 weeks after discharge between the two groups. However, the VATS group showed a trend toward less intraoperative blood loss (mean difference: -34.20; 95%CI: -162.89 to 94.49). VATS offers advantages over OT in organizing thoracic empyema surgery, particularly in terms of improved lung expansion at discharge. Further studies with larger sample sizes are warranted to support these findings.

Background Right lateral thoracotomy is increasingly used because of its cosmetic benefits, shorter hospital stays, rapid return to full activity, and ease of reoperation in pediatric patients with uncomplicated congenital heart disease. Currently, one-lung ventilation (OLV) is used in these children to facilitate surgical exposure. We aimed to assess the effect of OLV on postoperative outcomes. Methods Children aged 6 months to 6 years undergoing right lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) were randomized into an OLV group or a control group. For the OLV group, the tidal volume was 5 ml/kg with 6 cmH₂O positive end-expiratory pressure from the incision until the end of CPB, whereas patients in the control group received two-lung ventilation, except during vena cava occlusion. Lung ultrasonography was performed twice in the supine position for each patient: first, 3 min after intubation before surgery (T 1 ), and second, 3 min after lung recruitment maneuvers at the end of surgery (T 2 ). The primary outcome was the incidence of postoperative pulmonary complications within 72 h of surgery and significant atelectasis (defined by a consolidation score of ≥ 2 in any region) at T 2 . Results Overall, 54/96 (56.3%) children developed postoperative pulmonary complications after lateral thoracotomy cardiac surgery with CPB. The incidence of postoperative pulmonary complications was 52.1% (25/48) and 60.4% (29/48) in the OLV and control groups, respectively (odds ratio: 0.712; 95% confidence interval: 0.317–1.600; p  = .411). At the end of surgery, the incidence of significant atelectasis was 37.5% in the OLV group compared to 64.6% in the control group (odds ratio: 0.329; 95% confidence interval: 0.143–0.756; p  = .008). The consolidation score of the left lung (dependent lung) in the OLV group was significantly lower than that in the control group ( p  = .007); there was no significant difference in the right lung's postoperative consolidation score between the two groups ( p  = .051). Conclusions There was no significant difference in the incidence of postoperative pulmonary complications within 72 h of surgery between the two groups. However, children who underwent right lateral thoracotomy cardiac surgery with CPB in the OLV group showed a low incidence of atelectasis at the end of surgery. Trial registration ChiCTR, ChiCTR2100048720. Registered on July 13, 2021, www.chictr.org.cn .

To systematically evaluate the risk factors of conversion to thoracotomy in thoracoscopic surgery (VATS) for lung cancer, and to provide a theoretical basis for the development of personalized surgical plans. CNKI, Wanfang, VIP, CBM, PubMed, Cochrane Library, Web of Science, and Embase databases were searched by computer from the establishment of the database to March 2024. Relevant studies on the risk factors of conversion to thoracotomy in VATS for lung cancer were searched. Two reviewers independently performed literature screening, data extraction, and quality evaluation, and Stata16.0 software was used for data analysis. A total of 14 studies were included in this study, with a total sample size of 10605, and a total of 11 risk factors were obtained. Mate analysis showed that, Age ≥ 65 years old [OR(95%CI) = 2.61(1.67,4.09)], male [OR(95%CI) = 1.46(1.19,1.79)], BMI(Body Mass Index) ≥ 25 [OR(95%CI) = 1.79(1.17,2.74)], tuberculosis history [OR(95%CI) = 7.67(4.25,13.83)], enlarged mediastinal lymph nodes [OR(95%CI) = 2.33(1.50,3.06)], lung door swollen lymph nodes [OR(95%CI) = 6.33(2.07,19.32)], pleural adhesion [OR(95%CI) = 2.50(1.93,3.25)], tumor located in the lung Upper lobe [OR(95%CI) = 4.01(2.87,5.60)], sleeve lobectomy [OR(95%CI) = 3.40(1.43,8.08)], diameter of tumor ≥ 3.5cm [OR(95%CI) = 2.13(1.15,3.95)] associated with lung cancer VATS transit thoracotomy. Age ≥ 65 years old, male, BMI ≥ 25, tuberculosis history, enlarged mediastinal lymph nodes, lung door swollen lymph nodes, pleural adhesion, tumor located in the lung Upper lobe, sleeve lobectomy, diameter of tumor ≥ 3.5cm are risk factors for conversion to thoracotomy during VATS for lung cancer. Clinicians should pay attention to the above factors before VATS to avoid forced conversion due to the above factors during VATS. Due to the number and limitations of the included studies, the above conclusions need to be validated by additional high-quality studies. The protocol was registered into the PROSPERO database under the number CRD42023478648.

Background The most common surgery for non-small cell lung cancer is lobectomy, which can be performed through either thoracotomy or video-assisted thoracic surgery (VATS). Insufficient research has examined respiratory muscle function and exercise capacity in lobectomy performed using conventional thoracotomy (CT), muscle-sparing thoracotomy (MST), or VATS. This study aimed to assess and compare respiratory muscle strength, diaphragm thickness, and exercise capacity in lobectomy using CT, MST, and VATS. Methods The primary outcomes were changes in respiratory muscle strength, diaphragm thickness, and exercise capacity. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were recorded for respiratory muscle strength. The 6-min walk test (6MWT) was used to assess functional exercise capacity. Diaphragm thickness was measured using B-mode ultrasound. Results The study included 42 individuals with lung cancer who underwent lobectomy via CT ( n = 14), MST ( n = 14), or VATS ( n = 14). Assessments were performed on the day before surgery and on postoperative day 20 (range 17–25 days). The decrease in MIP ( p < 0.001), MEP ( p = 0.003), 6MWT ( p < 0.001) values were lower in the VATS group than in the CT group. The decrease in 6MWT distance was lower in the MST group than in the CT group ( p = 0.012). No significant differences were found among the groups in terms of diaphragmatic muscle thickness ( p > 0.05). Conclusion The VATS technique appears superior to the CT technique in terms of preserving respiratory muscle strength and functional exercise capacity. Thoracic surgeons should refer patients to physiotherapists before lobectomy, especially patients undergoing CT. If lobectomy with VATS will be technically difficult, MST may be an option preferable to CT because of its impact on exercise capacity.

Purpose Non-small cell lung cancer (NSCLC) constitutes a substantial global health challenge, with surgical resection serving as a principal therapeutic approach. Nevertheless, the frequency of exploratory thoracotomy without en-bloc resection remains significant, particularly in advanced-stage cases, thereby adversely affecting prognosis. This study aims to predict risk scores for exploratory thoracotomy and analyze postoperative survival in patients with central NSCLC, utilizing CT (computed tomography) imaging subsequent to neoadjuvant therapy. Methods Clinical and radiological data of central NSCLC patients who underwent R0 resection or exploratory thoracotomy from January 2017 to June 2023 were retrospectively reviewed. Independent risk factors for exploratory thoracotomy were identified through a multivariate regression analysis. Subsequently, a nomogram model was developed to assess the risk of exploratory thoracotomy, and was validated through internal and external cohorts. Postoperative disease-free survival (DFS) and overall survival (OS) were analyzed using a Cox regression model. Results A total of 78 who underwent R0 resection following neoadjuvant therapy and 32 patients who underwent exploratory thoracotomy were included in the analysis. The nomogram model derived from tumor area and vascular deformation both identified as independent risk factors for exploratory thoracotomy, exhibited robust predictive performance. Furthermore, a tumor area of less than 250 mm² at the critical CT slice was associated with better DFS and OS following neoadjuvant therapy and R0 resection. Postoperative immunotherapy has the potential to extend survival in cases where exploratory thoracotomy was performed. Conclusion CT imaging at the critical slice post-neoadjuvant therapy is crucial for predicting the risk of exploratory thoracotomy and postoperative survival in patients with central NSCLC.

Objective To compare long term survival after minimally invasive lobectomy and thoracotomy lobectomy.Design Propensity matched analysis.Setting Surveillance, Epidemiology and End Results (SEER)-Medicare database.Participants All patients with lung cancer from 2007 to 2009 undergoing lobectomy.Main outcome measure Influence of less invasive thoracoscopic surgery on overall survival, disease-free survival, and cancer specific survival.Results From 2007 to 2009, 6008 patients undergoing lobectomy were identified (n=4715 (78%) thoracotomy). The median age of the entire cohort was 74 (interquartile range 70-78) years. The median length of follow-up for entire group was 40 months. In a matched analysis of 1195 patients in each treatment category, no statistical differences in three year overall survival, disease-free survival, or cancer specific survival were found between the groups (overall survival: 70.6% v 68.1%, P=0.55; disease-free survival: 86.2% v 85.4%, P=0.46; cancer specific survival: 92% v 89.5%, P=0.05).Conclusion This propensity matched analysis showed that patients undergoing thoracoscopic lobectomy had similar overall, cancer specific, and disease-free survival compared with patients undergoing thoracotomy lobectomy. Thoracoscopic techniques do not seem to compromise these measures of outcome after lobectomy.

Background Lung cancer surgery has evolved significantly, with minimally invasive video-assisted thoracic surgery (VATS) procedures being compared with traditional open thoracotomies. The incidence of postoperative wound infections is a significant factor influencing the choice of surgical technique. This systematic review and meta-analysis aim to evaluate the impact of thoracoscopic versus open thoracotomy procedures on postoperative wound infections in lung cancer patients. Methods Following PRISMA guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on September 19, 2023, without time or language restrictions. Peer-reviewed randomized controlled trials, cohort studies, and case-control studies reporting on postoperative wound infections were included. Studies not differentiating between surgical techniques or focusing on irrelevant populations were excluded. Data extraction and quality assessment were independently carried out by two reviewers, using a fixed-effect model for meta-analysis due to the absence of significant heterogeneity (I 2  = 0.0%, P  = 0.766). Results A total of six articles were included. The quality assessment indicated a low risk of bias in most domains. The pooled results showed that open thoracotomy procedures had a twofold increased risk of postoperative wound infections (OR = 2.00, 95% CI: 1.04–3.85) compared to VATS procedures. Publication bias assessment using funnel plots and Egger’s test revealed no significant biases ( P  > 0.05). Conclusions The findings suggest that VATS is associated with a lower risk of postoperative wound infections compared to open thoracotomy, which has implications for surgical decision-making in lung cancer treatment. Clinical trial number Not applicable.