How to Give Effective Formative Feedback in Thoracic Surgery Education
Unfortunately, evidence-based models of formative feedback are rare in graduate medical education. Adapting models developed in K-12 learning is a surrogate but with some exceptions. One of these models is presented in the context of thoracic surgical education. Its utility is demonstrated when delivering formative feedback. The recognized few but key differences between K-12 education and graduate medical education regarding how feedback works are highlighted. These can limit feedback ’s effectiveness and so suggestions from the literature to avoid their impact are offered. The work is summarized with a set of guide...
Source: Thoracic Surgery Clinics - May 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Ara A. Vaporciyan Source Type: research

Educational Challenges of the Operating Room
Resident education in the operating room and surgical resident autonomy represent two enormous challenges within cardiothoracic (CT) training programs. The goal of surgical educators and CT trainees is to ensure the graduating resident's ability to safely operate independently at the completion of training. The field has come a long way from the notion of see one, do one, teach one, which was once the norm. Cardiothoracic surgery continues to become more specialized and the patients more complex with greater scrutiny of outcomes. There are many challenges that are faced in contemporary CT training to make intraoperative te...
Source: Thoracic Surgery Clinics - May 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Christopher R. Morse, Douglas J. Mathisen Source Type: research

E-Learning Trends and How to Apply Them to Thoracic Surgery Education
Education in all fields is vastly different today than it was 20  years ago. Constraints on time, access to clinical material and the speed of change mandate new more efficient approaches to education. Today, the Internet is a powerful tool that students and educators use to supplement or replace traditional learning. This technique, referred to as E-learning, c an deliver a broad array of solutions that enhance knowledge and performance. We review some of the current applications of E-learning in cardiothoracic surgery and suggest some future applications that may further enhance the efficiency of cardiothoracic surg...
Source: Thoracic Surgery Clinics - May 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Lauren Aloia, Ara A. Vaporciyan Source Type: research

Deliberate Practice and the Emerging Roles of Simulation in Thoracic Surgery
This article provides a focused synthesis of evidence regarding the usefulness of simulation-based training and deliberate practice as a whole and within the subspecialty of cardiothoracic surgery. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Phillip G. Rowse, Joseph A. Dearani Source Type: research

Artificial Intelligence
Artificial intelligence (AI) is being rapidly integrated into various medical applications. Although early application of AI has been achieved in image-based, as well as statistical computational models, translation into procedure-based specialties such as surgery may take longer to achieve. A potential application of AI in surgical education is as a teaching coach or mentor that interacts with the used via virtual and/or augmented reality. The question arises as to whether machines will achieve the wisdom and intelligence of human educators. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Ahmad Y. Sheikh, James I. Fann Source Type: research

Obtaining Meaningful Assessment in Thoracic Surgery Education
Training in thoracic surgery has evolved immensely over the past decade due to the advent of integrated programs, technological innovations, and regulations on resident duty hours, decreasing the time trainees have to learn. These changes have made assessment of thoracic surgical trainees even more important. Shifts in medical education have increasingly emphasized competency, which has led to novel competency-based assessment tools for clinical and operative assessment. These novel tools take advantage of simulation and modern technology to provide more frequent and comprehensive assessment of the surgical trainee to ensu...
Source: Thoracic Surgery Clinics - May 17, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Amy L. Holmstrom, Shari L. Meyerson Source Type: research

Unconscious Bias
This article provides a framework for exploring the implications for unconscious bias in surgical education and highlights best practices toward minimizing its impact. Presented is the background related to some of the more common unconscious biases and effects on medical students, resident trainees, and academic faculty. Finally, targeted strategies are highlighted for individuals and institutions for identification of biases and the means to address them. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 17, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Leah M. Backhus, Natalie S. Lui, David T. Cooke, Errol L. Bush, Zachary Enumah, Robert Higgins Source Type: research

Faculty Development
Faculty development is important at any level of academic rank but is especially important in early stages. The clinical educator is a rewarding pathway that is emerging as a special track for promotion and advancement. Success is achievable through development of skills, measurement of progress, obtaining funding, and completion of projects through publication. Advanced degrees, mentorship, and persistence are keys to achievement. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - May 17, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Gregory D. Rushing, Nahush A. Mokadam Source Type: research

Surgical Techniques for Myasthenia Gravis
Robotic-assisted thoracoscopic surgery (RATS) creates an extended approach for thymectomy in terms of locating contralateral phrenic nerve and upper poles of the thymus. RATS thymectomy is indicated in all non-thymomatous myasthenia gravis (MG) patients and thymomatous MG patients with resectable thymoma, typically Masaoka-Koga I and II. Left-sided RATS thymectomy is superior for anatomic reasons and in the special care patients with MG. Up to now, left-sided three-trocar RATS thymectomy is the perfect combination of radical resection and minimal invasiveness among various approaches for thymectomy. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Feng Li, Mahmoud Ismail, Aron Elsner, Deniz Uluk, Gero Bauer, Andreas Meisel, Jens-C. Rueckert Source Type: research

Uniportal Video-Assisted Transcervical Thymectomy
Surgery has proven superiority over medical management for patients with nonthymomatous myasthenia gravis. The key is complete resection of the gland, which can be achieved with various techniques. The uniportal video-assisted transcervical technique allows minimally invasive surgery with a low complication rate, a good cosmetic result, and a short length of recovery. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Philippe H. Lema ître, Shaf Keshavjee Source Type: research

Technique for Myasthenia Gravis
Kido and colleagues in 1999 used for the first time the subxiphoid approach. Recently, video-assisted thoracoscopic surgery (VATS) thymectomy has been improved for the advancement of surgical materials and new instruments. The most important aspect regarding the subxiphoid approach is the possibility to avoid the intercostal nerve damage with the consequence of a decreased use of postoperative analgesics, quite short surgical duration, fast discharge from hospital and a guarantee of successful cosmetics results. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Beatrice Aramini, Jiang Fan Source Type: research

History of Thymectomy for Myasthenia Gravis
In the early 1900s, chance observations of improved symptoms in several myasthenic patients undergoing thyroidectomy for goiters with concomitant resection of the adjacent thymus gland, first suggested a possible association between the thymus and myasthenia gravis. With the remarkable progress made in the understanding and treatment of myasthenia and in the anesthetic, surgical, and postoperative management of patients undergoing thoracic procedures, the initial high morbidity and mortality associated with thymectomy have been all but eliminated, and thymectomy is frequently incorporated into the long-term management stra...
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Joel D. Cooper Source Type: research

Preface
I am pleased to present this Thoracic Surgery Clinics dedicated to myasthenia gravis (MG) and thymectomy. The recent international prospectively randomized trial of thymectomy for MG (MGTX trial) has finally proven the effectiveness of thymectomy in nonthymomatous MG. The historical road to enable definitive proof of the role and effectiveness of thymectomy was led by many surgical leaders and thoracic surgical legends. We should be particularly indebted to Dr Fred Jaretzki, whose surgical leadership enabled the randomized international trial to come to fruition. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Joshua R. Sonett Source Type: research

Thymectomy for Myasthenia Gravis
THORACIC SURGERY CLINICS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Joshua R. Sonett Source Type: research

Copyright
ELSEVIER (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contributors
M. BLAIR MARSHALL, MD, FACS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
Joshua R. Sonett (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Forthcoming Issues
Thoracic Surgical Education: Current and Future Strategies (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - March 28, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

A Neurologist ’s Perspective on Understanding Myasthenia Gravis
Myasthenia gravis (MG) is a disease of neuromuscular transmission caused by antibodies directed toward proteins concentrated at the neuromuscular junction. Mild to life-threatening weakness varies in severity over time and with level of activity. Therefore, clinical diagnosis is often challenging. MG may be categorized by autoantibody type, thymic pathologic condition, and age of onset. Treatments are tailored for each group. A key management concern is severe exacerbation of weakness resulting from infections or exposure to certain medications, including antibiotics, which may be severe enough to produce respiratory decom...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Loulwah Mukharesh, Henry J. Kaminski Source Type: research

Non-Myasthenia Gravis Immune Syndromes and the Thymus
Thymectomy has long been considered, performed, and discussed for many different nonmyasthenic immune syndromes. Thymectomy is now an established treatment for MG, and has been performed for other immune syndromes with varying degrees of improvement. Although numerous reports document immune syndromes ’ association with thymoma, few address the role of thymectomy in symptom resolution. This review assesses thymectomy in the various nonmyasthenic immune syndromes for which it has been tried. Based on this review, it seems appropriate to revisit a more active role for thymectomy in pure red cell aplasia, pemphigus, rhe...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Sean C. Wightman, Joseph B. Shrager Source Type: research

The Role of the Thymus in the Immune Response
The thymus is a primary lymphoid organ essential for the development of T lymphocytes, which orchestrate adaptive immune responses. T-cell development in the thymus is spatially regulated; key checkpoints in T-cell maturation and selection occur in cortical and medullary regions to eliminate self-reactive T cells, establish central tolerance, and export na ïve T cells to the periphery with the potential to recognize diverse pathogens. Thymic output is also temporally regulated due to age-related involution of the thymus accompanied by loss of epithelial cells. This review discusses the structural and age-related ...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Puspa Thapa, Donna L. Farber Source Type: research

A Neurologist ’s Perspective to Understanding Myasthenia Gravis
Myasthenia gravis (MG) is a disease of neuromuscular transmission caused by antibodies directed toward proteins concentrated at the neuromuscular junction. Mild to life-threatening weakness varies in severity over time and with level of activity. Therefore, clinical diagnosis is often challenging. MG may be categorized by autoantibody type, thymic pathologic condition, and age of onset. Treatments are tailored for each group. A key management concern is severe exacerbation of weakness resulting from infections or exposure to certain medications, including antibiotics, which may be severe enough to produce respiratory decom...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Loulwah Mukharesh, Henry J. Kaminski Source Type: research

A Neurologist ’s Perspective on Thymectomy for Myasthenia Gravis
The first randomized blinded study of thymectomy in nonthymomatous myasthenia gravis was designed to answer 3 questions: does the combination of prednisone and removal of the thymus gland via extended transsternal thymectomy after 3  years compared with an identical dosing protocol of prednisone alone (1) lead to better disease status for generalized MG patients with antiacetylcholine receptor antibodies, (2) reduce their prednisone requirements, and/or (3) reduce the side-effect burden from medications used to treat the disea se? The study demonstrated that thymectomy confers these benefits for patients and sets the ...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Wentao Mi, Nicholas J. Silvestri, Gil I. Wolfe Source Type: research

Surgical Approaches to Myasthenia Gravis
The effectiveness of thymectomy for nonthymomatous myasthenia gravis is analyzed with regard to extensiveness of removal of the adipose tissue of the mediastinum and the lower neck region with various techniques of thymectomy. The approach necessary to achieve maximal radicality must include access to both pleural cavity and the lower neck area up to the thyroid gland. Surgical techniques include extended transsternal approach, which might be combined with separate transcervical incision, bilateral videothoracoscopic (VATS) approach combined with transcervical incision, and extended subxiphoid approach, either uniportal or...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Marcin Zieli ński Source Type: research

Surgical Techniques for Myasthenia Gravis
We describe the various video-assisted thoracic surgery approaches to the thymus currently adopted in nonthymomatous and thymomatous myasthenic patients. Despite several controversies, video-assisted thoracic surgery thymectomy gained worldwide popularity. Classic 3-port approaches proved safe and effective. Uniportal video-assisted thoracic surgery requires consolidated experience, whereas the bilateral approach is considered more extensive. Subxiphoid represents the ultimate and exciting challenge. As an effect of video-assisted thoracic surgery approach, thymectomy is performed earlier; both patients and neurologists ar...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Tommaso Claudio Mineo, Vincenzo Ambrogi Source Type: research

Surgical Decision Making
About 15% of patients with myasthenia gravis are affected by thymoma. Precise tumor staging is necessary to plan the appropriate operation. In early stages, complete surgical resection is the mainstay of treatment. Minimally invasive approaches can be safely performed by highly trained surgeons, and may be preferred in myasthenic patients because they can ensure optimal results from the oncological, neurologic, and surgical point of views, avoiding the complications of open approach. For advanced stage thymoma in myasthenic patients, a careful, multidisciplinary planning of the therapeutic approach must be undertaken, part...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Giovanni M. Comacchio, Giuseppe Marulli, Marco Mammana, Giuseppe Natale, Marco Schiavon, Federico Rea Source Type: research

Non –Myasthenia Gravis Immune Syndromes and the Thymus
Thymectomy has long been considered, performed, and discussed for many different nonmyasthenic immune syndromes. Thymectomy is now an established treatment for MG, and has been performed for other immune syndromes with varying degrees of improvement. Although numerous reports document immune syndromes ’ association with thymoma, few address the role of thymectomy in symptom resolution. This review assesses thymectomy in the various nonmyasthenic immune syndromes for which it has been tried. Based on this review, it seems appropriate to revisit a more active role for thymectomy in pure red cell aplasia, pemphigus, rhe...
Source: Thoracic Surgery Clinics - March 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Sean C. Wightman, Joseph B. Shrager Source Type: research

Medical Management of Pulmonary Nontuberculous Mycobacterial Disease
This article focuses on the most common NTM species known to cause human lung disease and the treatment options currently available. The diagnosis of NTM lung disease is also discussed, emphasizing the necessity for treating clinicians to have sufficient familiarity of the mycobacteria laboratory to provide optimal patient management. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Julie V. Philley, David E. Griffith Source Type: research

History of Pulmonary Tuberculosis
This article highlights the history of pulmonary TB from the onset of human existence to the present. Despite its long history, TB was slowly identified as a major cause of disease, and defined causation and significant treatment strategies advances over the past 150  years. TB remains a major challenge for definitive global prevention and cure. This article gives a brief overview of the history of TB. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: A. Thomas Pezzella Source Type: research

Surgical Resection in the Treatment of Pulmonary Tuberculosis
This article discusses the main indications, contraindications, features of operations, and perioperative period. This information is useful for practicing surgeons and specialists in the treatment of pulmonary tuberculosis. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Piotr K. Yablonskii, Grigorii G. Kudriashov, Armen O. Avetisyan Source Type: research

Current Medical Management of Pulmonary Tuberculosis
Tuberculosis (TB) remains a common cause of infection and disease in much of the world. The majority of disease occurs from reactivation months or years after initial infection and most often involves the lungs. Sputum smears for acid-fast bacilli remain the initial diagnostic test but have limited sensitivity and specificity. Nucleic acid amplification tests are more sensitive and specific and can detect some mutations that cause drug resistance. Treatment of TB resistant to rifamycins alone or in combination with isoniazid and other drugs remains difficult and should be done in consultation with an expert in treating dru...
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Robert W. Belknap Source Type: research

Modern Collapse Therapy for Pulmonary Tuberculosis
Multidrug-resistant tuberculosis (TB), extensively drug-resistant TB, and TB –human immunodeficiency virus (HIV) coinfection require a special approach in anti-TB treatment. Most patients cannot be successfully cured by conventional chemotherapy alone. They need a modern approach using minimally invasive therapeutic and surgical techniques. The novel approaches of collapse therapy techniques and minimally invasive osteoplastic thoracoplasty increase the effectiveness of complex anti-TB therapy. Achieving the required selective collapse of lung tissue in destructive pulmonary TB, especially in cases of drug resistance...
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Denis V. Krasnov, Sergey V. Skluev, Yana K. Petrova, Dmitry A. Skvortsov, Vladimir A. Krasnov, Irina G. Felker, Nikolay Grischenko Source Type: research

Nontuberculous Mycobacteria
This article reviews the current epidemiology of nontuberculous mycobacterial pulmonary disease and the impact on thoracic disease. The prevalence of nontuberculous pulmonary disease in the United States is much higher than that of Mycobacterium tuberculosis. Estimates support an annual increase in incidence of 8% per year. Nontuberculous mycobacteria are distinguished by 2 group designations, slowly growing mycobacteria, such as Mycobacterium avium complex, and rapidly growing mycobacteria, which includes Mycobacterium abscessus. Most pulmonary infections in humans are caused by species belonging to M avium complex. This ...
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Wendi K. Drummond, Shannon H. Kasperbauer Source Type: research

Mycobacterial Musculoskeletal Infections
This article discusses clinical manifestations of musculoskeletal infections caused by Mycobacterium tuberculosis and nontuberculous mycobacteria. Pathogenesis, unique risk factors, and diagnostic and therapeutic approaches are reviewed. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: John I. Hogan, Roc ío M. Hurtado, Sandra B. Nelson Source Type: research

Nontuberculous Mycobacterial Infections in Cystic Fibrosis
Nontuberculous mycobacteria (NTM) are important emerging cystic fibrosis (CF) pathogens, with estimates of prevalence ranging from 6% to 13%. Diagnosis of NTM disease in patients with CF is challenging, as the infection may remain indolent in some, without evidence of clinical consequence, whereas other patients suffer significant morbidity and mortality. Treatment requires prolonged periods of multiple drugs and varies depending on NTM species, resistance pattern, and extent of disease. The development of a disease-specific approach to the diagnosis and treatment of NTM infection in CF patients is a research priority, as ...
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Stacey L. Martiniano, Jerry A. Nick, Charles L. Daley Source Type: research

Tuberculosis in Children
Mycobacterium tuberculosis is the leading cause of death worldwide from a single bacterial pathogen. The World Health Organization estimates that annually 1 million children have tuberculosis (TB) disease and many more harbor a latent form. Accurate estimates are hindered by under-recognition and challenges in diagnosis. To date, an accurate diagnostic test to confirm TB in children does not exist. Treatment is lengthy but outcomes are generally favorable with timely initiation. With the End TB Strategy, there is an urgent need for improved diagnostics and treatment to prevent the unnecessary morbidity and mortality from T...
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Tania A. Thomas Source Type: research

The Global Fight Against Tuberculosis
An estimated 1.7 billion (23%) of the world ’s population is infected with Mycobacterium tuberculosis leading to more than 10 million new tuberculosis (TB) cases each year. TB is one of the top 10 causes of death globally and is the leading cause of death from a single infectious disease agent. The World Health Organization’s ambitious En d TB Strategy aims to achieve a 95% reduction in TB deaths and 90% reduction in TB incidence rates by 2035. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Charles L. Daley Source Type: research

Surgical Treatment of Pulmonary Nontuberculous Mycobacterial Infections
Adjuvant surgical resection in the setting of pulmonary nontuberculous mycobacterial (NTM) infection removes focal parenchymal disease thought to serve as a poorly perfused “reservoir” for organisms, thus resistant to standard antimicrobial therapy. Removal of these areas of damaged lung is felt to enhance the effectiveness of the medical treatment. In general, these operations are associated with low morbidity and mortality, although resections that are more exten sive carry higher risk. Many of the planned operations may be performed with minimally invasive techniques. More data are needed regarding long-term...
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: John D. Mitchell Source Type: research

A Tale of Two Infections
Borrowing from Charles Dickens, the current status of pulmonary mycobacterial disease, worldwide, is a tale of two infections. Certainly on a global scale, the main threat remains disease  due to Mycobacterium tuberculosis (MTB), affecting approximately one-third of the world’s population and over 9 million new cases annually. An increasing proportion of these individuals present with (or develop) drug-resistant tuberculosis, making medical treatment alone less effective. In 2016, the World Health Organization included, for the first time, recommendations regarding the selective use of surgery in the treatment o...
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: John D. Mitchell Tags: Preface Source Type: research

Surgery for Pulmonary Mycobacterial Disease
THORACIC SURGERY CLINICS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Authors: John D. Mitchell Source Type: research

Copyright
ELSEVIER (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contributors
M. BLAIR MARSHALL, MD, FACS (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
John D. Mitchell (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Forthcoming Issues
Thymectomy for Myasthenia Gravis (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - November 17, 2018 Category: Cardiovascular & Thoracic Surgery Source Type: research

Endoscopic Approaches to Cricopharyngeal Myotomy and Pyloromyotomy
Endoscopic cricopharyngeal myotomy has been demonstrated to be a safe and efficacious procedure with favorable outcomes for the treatment of cricopharyngeal dysfunction with or without Zenker diverticulum. It is a less invasive approach with decreased morbidity compared with the open approach and minimal reported complications. Peroral endoscopic pyloromyotomy is a novel technique for the treatment of gastroparesis. It has shown promising results in terms of its safety, complication profile, and symptom improvement in a minimally invasive approach that is appealing to many patients. As further data emerge on the technique,...
Source: Thoracic Surgery Clinics - October 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Anee Sophia Jackson, Ralph W. Aye Source Type: research

Management of the Difficult Hiatal Hernia
The ideal operative solution to giant paraesophageal hernias involves a complex evaluation of the functional anatomy and the intraoperative assessment of both esophageal length and crural closure tension. The addition of surgical adjuncts such as extended transmediastinal dissection, Collis gastroplasty, and mesh reinforcement are all necessary, on an individualized basis, to address these 2 primary causes of hernia recurrence. We discuss the options available. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Matthew Rochefort, Jon O. Wee Source Type: research

Endoluminal Therapies for Esophageal Perforations and Leaks
Esophageal perforation has historically been a devastating condition resulting in high morbidity and mortality. The use of endoluminal therapies to treat esophageal leaks and perforations has grown exponentially over the last decade and offers many advantages over traditional surgical intervention in the appropriate circumstances. New interventional endoscopic techniques, including endoscopic clips, covered metal stents, and endoluminal vacuum therapy, have been developed over the last several years to manage esophageal perforation in an attempt to decrease the related morbidity and mortality. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Jeffrey R. Watkins, Alexander S. Farivar Source Type: research

Extraluminal Approaches to Gastroesophageal Reflux Disease
Gastroesophageal reflux disease (GERD) is a common affliction in Western society. In patients in whom GERD is resistant to medical therapy or who desire nonpharmacological definitive therapy, several surgical interventions are available. The most common and traditional surgical therapy is partial or complete gastric fundoplication; however, new alternatives, including the magnetic augmentation system LINX and EndoStim device, are increasingly common and efficacious. (Source: Thoracic Surgery Clinics)
Source: Thoracic Surgery Clinics - October 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: James M. Tatum, John C. Lipham Source Type: research

Mucosal Ablation Techniques for Barrett ’s Esophagus and Early Esophageal Cancer
Patients with esophageal intestinal metaplasia, or Barrett's esophagus, may undergo dysplastic changes that eventually lead to invasive adenocarcinoma. Endoscopic therapy in the form of radiofrequency ablation and cryoablation has been described as a minimally invasive intervention to halt this sequence of dysplasia to carcinoma. Studies demonstrate that the use of radiofrequency ablation and cryoablation is highly successful at eradicating intestinal metaplasia and dysplasia and reducing the risk of disease progression. Furthermore, these modalities also may be used in combination with endoscopic mucosal resection, or as ...
Source: Thoracic Surgery Clinics - October 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Ravi Rajaram, Wayne L. Hofstetter Source Type: research

Peroral Endoscopic Myotomy for Achalasia
Peroral endoscopic myotomy surgery is an incisionless, minimally invasive, natural orifice technique used to treat the symptoms of achalasia and other spastic disorders of the esophagus. Recent experience demonstrates that it can be performed safely by experienced esophageal surgeons and there are very good short-term outcomes comparable to laparoscopic myotomy. The rapid worldwide adoption of this technique demonstrates its potential to replace the current therapies available for achalasia. A cautionary note is important in that long-term outcomes are not yet available in terms of dysphagia and GERD symptoms. (Source: Tho...
Source: Thoracic Surgery Clinics - October 4, 2018 Category: Cardiovascular & Thoracic Surgery Authors: Lara W. Schaheen, Manuel Villa Sanchez, James D. Luketich Source Type: research