Introduction

Article Outline

• Minimally Invasive Mitral Repair—Thoracoscopic or Robotic?
• Patent Ductus and Vascular Ring: Thoracoscopic versus Robotic Approach
• Chest Wall and Vertebral Body Resection for Lung Cancer
• Copyright

This issue describes newer and alternative approaches to three important cardiothoracic surgical problems: (1) mitral valve repair; (2) patent ductus arteriosus/vascular ring; and (3) chest wall and vertebral body resection for lung cancer. We hope the readers will enjoy descriptions of new approaches to these particular problems from individuals who have been pioneers in their development.

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Minimally Invasive Mitral Repair—Thoracoscopic or Robotic? 

Minimally invasive approaches to mitral valve repair have become increasingly mainstream. Alternate incisions such as partial sternotomy and mini-thoracotomy are rapidly giving way to thoracoscopic and robotic techniques. Thus far, however, the role of each remains uncertain. Does using robotics add anything to the thoracoscopic approach? Our authors address these issues.

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Patent Ductus and Vascular Ring: Thoracoscopic versus Robotic Approach 

To date, thoracoscopic and robotic approaches have been largely applied to extracardiac congenital operations, including procedures for patent ductus arteriosus and vascular rings. These procedures, two of the oldest performed in cardiac surgery, have provided the substrate for advancing minimally invasive techniques in the field of congenital heart surgery. Redmond Burke from Miami Children’s Hospital describes the thoracoscopic approach to the patent ductus. Emile Bacha and Pedro del Nido from Children’s Hospital Boston present their use of the da Vinci Surgical System. Further evolution of these techniques in association with imaging advances, such as real-time, three-dimensional echocardiography, holds the potential for allowing closed, minimally invasive approaches to intracardiac repairs in the future.

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Chest Wall and Vertebral Body Resection for Lung Cancer 

The treatment of lung cancer invading the chest wall or vertebral column requires the surgeon not only to strive to achieve a R0 resection but frequently also to reconstruct the chest wall or stabilize the spine. Dr. Benjamin Kozower from the University of Virginia describes techniques of chest wall resection and reconstruction following en bloc partial chest wall resection for lung cancer. In the companion article, Dr. Valerie Rusch and colleagues from Memorial Sloan-Kettering Cancer Center provide a superb description of the technical points of vertebral body resection and the subsequent necessary instrumentation that is often required to stabilize the spine. This procedure is increasingly being recognized as an important treatment option in selected patients. Both of these well-illustrated articles provide the reader with a reference for the important technical points associated with concomitant chest wall or vertebral body resection in the surgical management of lung cancer.