Incomplete interlobar fissure complicates lobectomy and raises the risk of prolonged postoperative air leak. Although the fissureless fissure-last approach can reduce air leak in thoracoscopic surgery, its applicability in robot-assisted thoracoscopic surgery for left lower lobectomy remains uncertain. This study evaluated the feasibility of the fissureless fissure-last approach by comparing perioperative outcomes with those of the conventional interlobar approach. This single-center retrospective study included 53 patients with primary lung cancer who underwent robot-assisted left lower lobectomy between November 2019 and November 2024. They were divided into a fissureless fissure-last group (n = 13) and a conventional interlobar group (n = 40), and perioperative outcomes were compared. Patient characteristics did not differ significantly between the groups. The severe incomplete interlobar fissure proportion was significantly higher (77
To establish updated nationwide perioperative benchmarks for minimally invasive cardiac surgery (MICS) in Japan by presenting the 2023 annual report and summarizing procedural trends from 2021 to 2023. Data on mitral valve (MV) surgery, aortic valve replacement (AVR), coronary artery bypass grafting (CABG), atrial septal defect (ASD) closure, and cardiac tumor resection performed via MICS in 2023 were extracted from the Japan Cardiovascular Surgery Database. Perioperative outcomes, including 30-day mortality, in-hospital mortality, conversion to median sternotomy, and major morbidity, were evaluated. Three-year trends in case volume, institutional distribution, procedural complexity, and early outcomes were descriptively reviewed. The 2023 MICS cohort included the following cases: MV surgery (n = 3367), AVR (n = 1352), isolated CABG (n = 564), ASD closure (n = 232), and cardiac tumor resection (n = 126). Thirty-day and in-hospital mortality rates were 0.2
Preoperative nutritional status is a known prognostic factor in lung cancer surgery. However, its effect on postoperative pulmonary function over time remains unclear. This study evaluated the association between preoperative nutritional status and longitudinal respiratory changes andoutcomes after curative resection. Patients who underwent resection for non-small cell lung cancer between January 2020 and December 2024 were prospectively analyzed. Patients were classified by prognostic nutritional index (PNI) into normal (PNI ≥ 50) and malnutrition (PNI < 50) groups. Pulmonary function, including forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0), and diffusing capacity of the lung for carbon monoxide (
This study aimed to evaluate the association between preoperative pan-immune-inflammation value (PIV) and postoperative atrial fibrillation (POAF) after scheduled video-assisted thoracoscopic surgery (VATS) lobectomy. In addition, we assessed other complete blood count (CBC)-derived inflammatory indices and performed sensitivity analyses according to the interval between laboratory testing and surgery. This retrospective cohort study included adult patients scheduled for VATS lobectomy between January 2015 and November 2025. Patients with preexisting atrial fibrillation or other arrhythmias, active infection, hematologic or immunologic disease, intraoperative change in the extent of resection, additional concomitant surgery, or insufficient medical records were excluded. The primary outcome was POAF. Preoperative PIV and other CBC-derived inflammatory indices were compared between patients with and without POAF. Multivariable logistic regression was performed using log-transformed preoperative PIV, adjusted for age, conversion to thoracotomy, and estimated blood loss. Sensitivity and exploratory analyses were also conducted. Among 475 patients, POAF occurred in 42 patients (8.8
Minimally invasive direct coronary artery bypass (MIDCAB) via left anterior thoracotomy causes substantial early pain requiring opioids. The serratus anterior plane block (SAPB) is opioid-sparing, but data on a pre-emptive combined approach are limited. We evaluated its association with opioid administration and early recovery. Adults undergoing MIDCAB (January–December 2025) were retrospectively grouped by pre-emptive combined SAPB versus standard systemic analgesia. The primary outcome was 24-h postoperative intravenous morphine administration. Secondary outcomes were total morphine-equivalent administration including rescue tramadol, visual analogue scale pain scores, rescue analgesia, time to extubation, intensive care unit (ICU) and hospital stay, and opioid-related adverse events. Sixty-four patients were analyzed (SAPB, n = 33; control, n = 31). Twenty-four-hour intravenous morphine administration was lower with SAPB (9.15 ± 2.56 vs 12.71 ± 3.71 mg, p < 0.001), as was total morphine-equivalent administration (9.72 ± 3.14 vs 19.11 ± 5.80 mg, p < 0.001). Pain scores were lower at 12 h (1 [0–2] vs 4 [3–5]) and 24 h (0 [0–1] vs 3 [2–4]) (both p < 0.001), rescue analgesia was less frequent (6.1
This study aimed to evaluate the feasibility and mid-term outcomes of in situ aortic reconstruction using xenopericardial roll grafts for thoracic and thoracoabdominal native aortic and prosthetic graft infection. This retrospective single-centre study included consecutive patients who underwent xenopericardial roll graft replacement, including branched graft reconstruction and/or tissue filling, between 2010 and 2024. A multidisciplinary treatment strategy was adopted. This study included 21 patients who underwent 22 procedures (median age, 67 years; interquartile range, 63.75–73.75). On a procedure basis, the indications were infectious aortic aneurysm in 4 procedures and prosthetic graft infection in 18 procedures. Replacement sites included the ascending aorta (n = 4), aortic arch (n = 11), descending aorta (n = 6), and thoracoabdominal aorta (n = 1). Tissue filling was performed in 12 procedures. The 30-day and operative mortality rates were 13.6
Tracheal surgery is associated with substantial morbidity, and anastomotic failure can lead to life-threatening infectious complications such as mediastinitis. This study aimed to evaluate whether a biodegradable polylactide patch can close an experimental tracheal defect in mice and prevent such complications. In 30 male BALB/c mice, a window defect was created in the anterior tracheal wall. In Group 1 (control, n = 15) the defect was closed with two interrupted sutures only. In Group 2 (experimental, n = 15) the defect was repaired using an electrospun polylactide (PLA) patch secured with two interrupted sutures. Postoperative monitoring included daily semiquantitative clinical scoring (6 parameters, 0–3 scale) in addition to survival and histological assessment on days 7, 14, and 21. All mice in the experimental group survived with no signs of infection and clinical scores ≤ 1. In the control group, 5 of 15 mice developed cervical phlegmon (two died spontaneously, three were euthanized with purulent exudate); the other 10 mice without phlegmon survived. Histologically, the control group exhibited persistent inflammation, tissue disorganisation, and incomplete epithelial regeneration (flattened epithelium with occasional ciliated patches). The PLA patch group showed progressive polymer degradation, minimal inflammation, and complete restoration of a ciliated respiratory epithelium by day 21. The PLA patch prevented infectious complications and mortality, promoted full ciliated epithelialization, and demonstrated high biocompatibility, supporting its use in tracheal reconstructive surgery.
Intraoperative localization of small peripheral pulmonary nodules can be challenging due to the size, characteristics, or depth of nodules. This study introduced a computed tomography (CT)-guided skin marking method and evaluated its feasibility and accuracy. From January 2017 to January 2026, 89 patients underwent CT-guided skin marking followed by wedge lung resection. Eligible nodules were located in the outer third of the lung and measured ≤ 1 cm in diameter or ≤ 2 cm in maximum diameter, with a consolidation-to-tumor ratio of ≤ 0.25 were considered eligible. CT-guided skin marking was performed a day before surgery. During the operation, a port was created at the marked skin site, and a dyed cotton swab was used to mark the visceral pleura. Wedge resection was conducted using the pigmented mark as a guide. Distance from the marker to the visceral pleural surface directly above the lesion (hereinafter referred to as distance) was measured, and factors associated with a value of ≥ 10 mm were identified using logistic regression analysis. All nodules were completely resected without complications. The median distance was 6 (range: 0–25) mm. A greater chest wall thickness and a larger port insertion angle were significantly associated with distance of ≥10 mm. CT-guided skin marking is a simple and safe technique and does not require special equipment. Notably, distance increases in cases involving thick chest walls or large port insertion angles. Hence, this method can be a reliable and widely applicable approach for the accurate resection of small peripheral pulmonary nodules.
Robotic left main bronchial sleeve resection for endobronchial tumors avoids pneumonectomy while preserving the entire ipsilateral lung parenchyma. Preoperative three-dimensional computed tomography reconstruction guides dissection around the pulmonary artery, pulmonary veins, and left atrium, and Firefly fluorescence imaging enables precise intraoperative tumor localization without needle puncture. We hereby describe a patient with a typical carcinoid tumor of the left main bronchus, who successfully underwent a minimally invasive lung -preserving operation to achieve negative surgical margins via a left transthoracic approach.
Cisplatin-based adjuvant chemotherapy is the standard of care for patients with completely resected non-small cell lung cancer (NSCLC). However, carboplatin-based regimens are often selected in clinical practice for patients considered unsuitable for cisplatin, although evidence regarding their long-term survival outcomes remains limited. We conducted a meta-analysis to compare survival outcomes between cisplatin-based and carboplatin-based adjuvant chemotherapy in patients with completely resected NSCLC. PubMed and the Cochrane CENTRAL database were searched for relevant studies published up to April 7, 2026. Eligible studies included randomized and observational studies reporting hazard ratios (HRs) for overall survival (OS) and/or recurrence-free survival (RFS). A total of eight studies involving 2269 patients were included. The pooled HRs for OS and RFS indicated no significant differences between the two regimens (OS: HR, 1.08; 95
Objective analytical approaches for characterizing intraoperative grasping behavior have not yet been established, despite the availability of robotic systems capable of recording grasping-force data. This exploratory study aimed to objectively characterize object-specific grasping behavior during robot-assisted pulmonary resection using synchronized surgical video review and force-log analysis. Force data were collected from seven pulmonary resections performed using a robotic system equipped with haptic feedback and force-logging capability. Surgical videos were reviewed to identify grasping events involving five object categories: bronchial sheath, lung, lymph nodes, artificial materials, and vascular sheath. After force-log cleaning, five force-related features (peak force, mean force, mean-to-peak ratio, initial rising slope, and hold time) were extracted from each grasping event and compared among the object categories. A total of 271 grasping events comprising 64,765 force data points were analyzed. Significant differences were observed in all five force-related features among the object categories. Lymph nodes exhibited the lowest peak and mean forces, whereas artificial materials showed the highest forces and the steepest initial rising slope. Bronchial sheath and vascular sheath demonstrated similar force-related characteristics with intermediate forces and the gentlest initial rising slope. Subcategory analyses revealed additional differences, including higher forces in mediastinal than hilar lymph nodes and a steeper initial rising slope in lung-move than lung-hold maneuvers. Object-specific differences in force-related features enabled quantitative characterization of intraoperative grasping behavior during robot-assisted pulmonary resection. This exploratory study presents a methodological approach for objectively characterizing tissue-specific manipulation during robot-assisted pulmonary resection.
Despite high-level evidence support, the full Maze procedure remains underused because of complexity, prolonged arrest time, and training gaps. Therefore, we aimed to develop a simplified left atrial Maze procedure through the left atrial appendage. All patients with permanent atrial fibrillation treated using this technique between January 2024 and February 2025 were enrolled. The technique comprised (1) bilateral pulmonary vein isolation, (2) appendage-to-roof ablation, (3) appendage ridge ablation, (4) mitral annulus ablation, (5) endocardial bottom line ablation, (6) epicardial bottom line ablation, and (7) inferior vena cava and tricuspid line ablation. Left atrial Maze was performed through an amputated left atrial appendage. All ablation lines were created using the AtricureRF (AtriCure, Inc., Cincinnati, Ohio, United States) and CryoICE (AtriCure, Inc., Cincinnati, Ohio, United States) devices. Among 17 patients, six and 11 underwent aortic valve surgery and coronary bypass grafting, respectively. Atrial fibrillation was classified as long-standing in 13 patients and persistent in four. Surgical ablation through the left atrial appendage was completed within 20 min of cardiac arrest. Overall survival and freedom from recurrent atrial fibrillation at 12-month follow-up were 94
The Geriatric 8 (G8) screening tool is widely used to assess frailty in elderly patients with cancer. However, its significance in patients undergoing esophagectomy remains unclear. This study aimed to evaluate the association between preoperative G8 scores and postoperative outcomes in elderly patients who underwent esophagectomy for esophageal cancer. This study retrospectively analyzed 130 patients aged ≥ 65 years who underwent esophagectomy for esophageal cancer. The patients were classified into tertiles (low, medium, and high) based on their G8 scores. Postoperative and survival outcomes were compared, and multivariable logistic regression analysis was used to assess the association between G8 scores and postoperative outcomes. The median G8 score was 13 (interquartile range (IQR): 11.5–15). Postoperatively, severe complications occurred in 23.8
The hinotori™ Surgical Robotic System, the first domestically developed robotic platform in Japan, was approved for thoracic surgery in 2024. Although initial clinical experiences have been reported in other surgical fields, clinical data regarding its application in thoracic surgery remain extremely limited. This study aimed to describe the initial perioperative outcomes and feasibility of anatomical lung resection using the hinotori™ Surgical Robotic System with a standardized multiport approach. We retrospectively reviewed patients who underwent robotic surgery using the hinotori™ system at our institution between July 2024 and March 2026. During the study period, 106 robotic procedures were performed, including 81 anatomical lung resections. After excluding mediastinal tumor resections, combined procedures, and cases performed using the dual-port robotic approach, 60 patients who underwent anatomical lung resection using a standardized multiport robotic approach were included in the final analysis. A total of 60 patients were analyzed, including 36 lobectomies and 24 segmentectomies. No intraoperative complications or conversions to video-assisted thoracic surgery or thoracotomy occurred. Postoperative morbidity was observed in 9 patients (15.0
Maeda et al. recently proposed a model to predict long-term survival after isolated surgical aortic valve replacement (SAVR) in the transcatheter aortic valve replacement (TAVR) era. While the model shows encouraging discrimination and calibration, several methodological and clinical limitations may restrict its broader applicability. The authors selected the final six-variable model primarily on the basis of maximal five-year C-statistic, without formal sample size justification or contemporary shrinkage-based criteria. Validation was restricted to internal resampling within the same registry, limiting evidence for transportability. Important prognostic domains, notably frailty and key anatomical and comorbidity variables, were not incorporated, and performance was not directly compared with established risk scores. Reporting only partially aligns with modern prediction model guidelines and omits decision curve analysis, leaving clinical utility uncertain. Overall, the model represents a valuable step but requires methodological refinement and external validation before guiding lifetime management between SAVR and TAVR. EBM Rating: Level V evidence. The article represents expert opinion derived from the author’s clinical experience and interpretation of existing literature, without original experimental, randomized, controlled, cohort, or comparative analytic data.
The impact of preoperative veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support on outcomes of emergent pulmonary embolectomy for acute pulmonary embolism (PE) remains unclear. This study evaluated the safety and efficacy of preoperative VA-ECMO in patients undergoing emergent surgical embolectomy for high-risk PE. Between December 2007 and September 2025, 38 consecutive patients underwent emergent pulmonary embolectomy for acute PE. Patients were divided into two groups: without preoperative VA-ECMO (Group A, n = 17) and with preoperative VA-ECMO (Group B, n = 21). The primary outcome was a composite of in-hospital mortality and cardiopulmonary arrest (CPA) during anesthesia induction. Secondary outcomes included postoperative complications and long-term survival. Kaplan–Meier analysis was used to compare survival. Baseline characteristics were comparable between groups. Four patients in Group A (23.5
Robot-assisted thoracic surgery provides precise instrument control, but unexpected events may occur beyond bleeding control. We describe a practical recovery protocol for non-bleeding events during RATS. Representative events included visual loss, interface plate damage, unexpected vessel sealer motion, robotic arm excursion, and stapler–arm interference. Key steps were Stop Call, patient-side safety confirmation, verbal sharing, reassessment, conversion when safe recovery is not possible, and team agreement before restart.
