Minimally-Invasive Mediastinal Surgery

      In this issue of Operative Techniques there are two descriptions of minimally-invasive mediastinal surgery. While the majority of surgical approaches for mediastinal diseases traditionally involved a sternotomy or thoracotomy, advances over the past 10 to 15 years have resulted in more and more of these procedures being done with a minimally-invasive approach. In the first manuscript, Dr. Maddaus and colleagues from the University of Minnesota describe their approach to performing a thymectomy using a thoracoscopic or video-assisted thoracic surgery (VATS) approach. While this approach has been described from either the left or right hemithorax, I personally prefer the staged bilateral approach described in this article as it enhances complete removal of all thymic tissue and helps avoid the rare, but serious, complication of phrenic nerve injury. In the companion article Dr. Michael Reed from Penn State University details his approach to thoracoscopic resection of posterior mediastinal tumors. In this article he also describes the use of this approach, in selected cases, for dumbbell tumors involving the spinal canal. Collectively, these two papers highlight minimally-invasive approaches to tumors of the anterior and posterior mediastinal pleura and will be a valuable resource to all practicing thoracic surgeons.

      Cardiac Allo- and Auto-Transplantation: Technical Aspects

      The Adult Cardiac Surgery portion of the Summer Issue of 2010 for Operative Techniques contains three articles. The first is by Camp, and describes techniques of donor retrieval of organs for heart and lung transplantation. The paper carefully describes techniques for optimal protection and preservation of the organs. Furthermore, it details reproducible methods for ensuring that all recipients receive adequate cuffs of tissue for the implant procedures. Techniques of preservation are critical to the ultimate performance of successful transplant procedures. The manuscript by John and Liao depicts the technique of orthotopic heart transplantation. These authors include pointers on timing of the recipient operation to minimize donor ischemic time, as well as important steps to ensure a safe recipient operation. Both the biatrial and bicaval techniques of implantation are described and illustrated. Finally, Reardon describes the techniques of cardiac autotransplantation for cardiac neoplasms. This novel approach, pioneered by the author, has made possible surgical attack on tumors previously felt to be inoperable. Reardon outlines the keys to successful application of this technique, both from a planning as well as a technical standpoint.

      Berlin Heart and Transplantation for Congenital Defects

      The congenital section of this issue is devoted to transplantation-related topics. The approach to pretransplant support and the transplant operation itself offer numerous surgical challenges in children with congenital heart defects. Jake Jaquiss and Michiaki Imamura from Arkansas Children's Hospital cover implantation of the Berlin Heart ventricular assist device. Given the limitations of ECMO, the Berlin Heart has become the primary device available as a bridge to transplant. The authors detail their technical approach from an extensive experience. Leonard Bailey and Jose Montalvo from Loma Linda present the approach to both the donor operation and recipient implantation for patients with complex anatomy. Dr. Bailey pioneered infant and pediatric heart transplantation, and we are grateful for his contribution, covering more than 25 years of experience. His article details the technical approach to patients with a wide range of anatomic variations, including functional single ventricles, aortic arch anomalies, total anomalous pulmonary venous return, and situs inversus.