Extended pleurectomy and decortication: Video atlas of operative steps

摘要

Central MessageThe operative steps for an extended pleurectomy and decortication are described with a video atlas. An ePD can achieve a macroscopic complete resection for MPM with preservation of the lung.See Commentary on page 331.Feature Editor Note—Video Atlas Articles (VAAs) are peer-reviewed descriptions of an operative procedure distilled into a series of steps, with each step taught to the reader through its own narrated video and short corresponding text. The purpose of the VAA is to provide continuing surgical education in a format that is quality-assured, easily accessible, and high impact. Much of the excitement around our new series of VAAs surrounds robotic and thoracoscopic/laparoscopic procedures. Our field has progressed rapidly into one in which robotic and thoracoscopic surgery have improved clinical outcomes, and we drive much of the innovation in minimally invasive surgical platforms and technique. The ability to record high-resolution video during the routine conduct of robotic and thoracoscopic/laparoscopic surgery has facilitated this opportunity in structured, peer-reviewed, expert instruction of index cases in thoracic surgery and is the bedrock for the VAA initiative. Open surgery, however, has become less frequent in our training programs, and operations that are performed open are now more likely to be complex rather than routine cases. This highlights a gap in surgical training that can be narrowed with novel methods of continuing surgical education. In this VAA, the authors describe an extended pleurectomy/decortication procedure for malignant pleura mesothelioma in a structured and comprehensive series of 12 steps. High-resolutions videos recorded from a surgeon's headlight camera are provided for each step and allow the reader to experience the conduct of each step of this complex, open operation from the surgeon's perspective. This is the first VAA of an open procedure and showcases the potential of this format to advance continuing surgical education for open thoracic surgery.Bryan M. Burt, MDMalignant pleural mesothelioma (MPM) is the most common type of malignant mesothelioma, which arise from the pleural, peritoneum, pericardium, and tunica vaginalis. The incidence of MPM is about 3000 patients per year in the United States. The etiology of the majority of cases is asbestos exposure. Surgery with chemotherapy results in long-term survival in some patients.1Rusch V.W. Giroux D. Kennedy C. Ruffini E. Cangir A.K. Rice D. et al.Initial analysis of the international association for the study of lung cancer mesothelioma database.J Thorac Surgery has a in the and with and Surgery in malignant pleural Thorac The the for and of have that surgery for MPM for and D. pleural for and et malignant pleural mesothelioma, M. et of malignant pleural of macroscopic complete resection is the of D. et for of surgical for malignant pleural a of the for the study of and the Thorac pleurectomy and decortication for malignant pleural are MPM of the thoracic and resection of is The the for the of and the have the operations for achieve a macroscopic complete a surgery an extended pleurectomy/decortication a surgery an is et for malignant pleural mesothelioma, from the for the of Thorac and pleurectomy the resection of the are a resection be an ePD is in the the of an ePD is to the the steps to an This is and to most of this operation training is this operation is to a is an operative The and of clinical and of are for a that surgery, and clinical thoracoscopic surgery the of the of the to a in be and clinical The the thoracic and potential with more than with and to a of patients with that is on et surgical for malignant pleural Thorac et of malignant pleural mesothelioma with routine Thorac of in of operative pleural can to than the and can be performed during the of is to and are are to for an an ePD is The is to that with An for in which an ePD be performed is however, the are the lung likely An and an are be tha