Chapters authored
Malignant Pleural Mesothelioma and the Role of Non– Operative Therapies
Part of the book: Principles and Practice of Cardiothoracic Surgery
Role of Hybrid Operating Room: Present and Future
With the dramatic progress of medical imaging modalities and growing needs for high-resolution intraoperative imaging in minimally invasive surgery, hybrid operative room (OR) has been developed as a powerful tool for different surgical scenarios. Under the guidance of high-definition cone beam CT (CBCT), an electromagnetic navigation bronchoscopy (ENB)-based marker implantation and subsequent localization of the pulmonary nodules can be implemented within a hybrid OR. Furthermore, the unparalleled real-time imaging capabilities and the ability to perform multiple tasks within the hybrid OR can facilitate image-guided single-port video-assisted thoracic surgery (iSPVATS), increasing the precision and improving outcomes of the procedure. With the help of a hybrid theatre, catheter-based thermal ablation can provide a safer and less invasive treatment option for select patient groups with early-stage non-small cell lung carcinomas (NSCLC) or metastases. In the future, the combination of hybrid operating room and other inspiring innovative techniques, such as robotic bronchoscopy, 3D-printing, natural orifice transluminal endoscopic surgery (NOTES) lung surgery could lead to a paradigm shift in the way thoracic surgery is conducted.
Part of the book: Immunosuppression
Image-Guided Ablative Therapies for Lung Tumors
While the gold standard for early stage lung cancers is still surgical resection, many patients have comorbidities or suboptimal lung function making surgery unfavorable. At the same time, more and more small lung nodules are being incidentally discovered on computer tomography (CT), leading to the discovery of pre-malignant or very early stage lung cancers without regional spread, which could probably be eradicated without anatomical surgical resection. Various ablative energies and technologies are available on the market, including radiofrequency ablation, microwave ablation, cryoablation, and less commonly laser ablation and irreversible electroporation. For each technology, the mechanism of action, advantages, limitations, potential complications and evidence-based outcomes will be reviewed. Traditionally, these ablative therapies were done under CT guidance with percutaneous insertion of ablative probes. Recently, bronchoscopic ablation under ultrasound, CT, or electromagnetic navigation bronchoscopy guidance is gaining popularity due to improved navigation precision, reduced pleural-based complications, and providing a true “wound-less” option.
Part of the book: Lung Cancer