Controlled apneic tracheostomy in patients with coronavirus disease 2019 (COVID-19)To develop a team-based institutional infrastructure for navigating management of a novel disease, to determine a safe and effective approach for performing tracheostomies in patients with COVID-19 respiratory failure, and to review outcomes of patients and health care personnel following implementation of this approach.
Commentary: Coronavirus disease 2019 (COVID-19) and the airway: How can surgery help?We have read with interest the paper from Lucchi and colleagues1 reporting on one case of laryngotracheal resection for benign stenosis in a patient post-coronavirus disease 2019 (COVID-19); this is certainly one of the first reports in this setting. The Pisa University team has done a very good job in such a demanding condition. Moreover, this paper offers the opportunity to learn more about COVID-19 and related airway diseases; also, it gives us important insights about the role of surgery in this setting.
Commentary: Should surgeons challenge the unknown sequela of the coronavirus disease 2019 (COVID-19) virus?In the early 2020, the World Health Organization declared a global outbreak of the new coronavirus disease 2019 (COVID-19; severe acute respiratory syndrome coronavirus 2), and the situation was classified as an international emergency.1 Throughout the world, health care systems were forced to adopt changes to their practices and deal with a highly contagious and lethal virus. At the forefront of this pandemic, thoracic surgeons face challenges not only in defining the indications for life-saving procedures in patients with COVID-19 but also in adopting new tactics to safely perform surgery in infected, highly contagious patients.
Laryngotracheal resection for a post-tracheotomy stenosis in a patient with coronavirus disease 2019 (COVID-19)Coronavirus disease 2019 (COVID-19) has quickly spread worldwide since the first reported case1–3 in Wuhan, China. Patients who need hospitalization for respiratory support require, in about 10% of cases, oro-tracheal intubation (OTI) for invasive ventilation and a tracheotomy whenever the patient is intubated for a long time and the prognosis is good.4
Commentary: A limit of 0?The article by González-Rivas and colleagues1 implies that a uniportal approach can be applied to almost any complex thoracic procedure, therefore having no limits (to answer the titular question). Their experience builds on minimally invasive techniques and equipment innovations accrued over time and accelerated by iterative refinements occurring at institutions like the authors’ high-volume hospitals. When presenting such experiences, investigators have not been required to publish their overall use of that approach (counting both conversions and intended open cases in the denominator), so it is hard to know its complete impact.
Commentary: One port in a storm?It is always useful to see and read how experienced surgeons handle complicated and infrequently performed operations. When preparing for an operation such as sleeve resection it is common for surgeons to call upon the literature for review. The article by Gonzalez-Rivas and colleagues1 can certainly be helpful in this regard.
Technical aspects of uniportal video-assisted thoracoscopic sleeve resections: Where are the limits?Feature Editor's Note—Global enthusiasm for a uniportal approach to video-assisted thoracoscopic (VATS) resection of thoracic neoplasms has seen a surge during the past decade subsequent to the first reported case in 2010. Proponents of the approach argue for diminished postoperative pain, reduced hospital length of stay, and more rapid recovery compared with a 3-hole VATS technique. Of note, in the only published randomized study that compared uniportal with other VATS techniques for lobectomy, there was no difference in postoperative outcomes including pain, length of stay, or complications (Perna et al.