Recent clinical innovations in thoracic surgery in Hong Kong

Abstract

The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS. Our region has been the testing ground and has led the development of many of these innovations. Performing VATS, in particular single-port VATS in hybrid operating theatre helps to localise small pulmonary lesions with real-time images, thus increasing surgical accuracy and pushes the boundaries in treating subcentimeter diseases. Such approach may be assisted by use of electromagnetic navigational bronchoscopy in the same setting. In addition, sublobar resection can also be more individualised according to pathologic tumour subtype that require rapid intraoperative diagnostic test to guide appropriate surgical therapy. A focus on technology and innovation for large tumours that require chest wall resection and reconstructions have also been on going, with new materials and prostheses that may be tailored to each individual needs. The current paper reviews the literature pertaining to the above topics and discusses recent related innovations in Hong Kong, highlighting the study results and future perspectives.

Keywords: Electromagnetic navigational bronchoscopy; adenocarcinoma; hybrid operating theatre; single-port; video-assisted thoracic surgery (VATS).

Figure 1

Immediately after division of the left main pulmonary artery using the novel narrow four-row endocutter (Echelon Flex^TM, Ethicon Endo-Surgery, Inc., Cincinnati, OH, USA) during single port VATS pneumonectomy. VATS, video-assisted thoracic surgery.

Figure 2

Electromagnetic navigational bronchoscopy performed in our hybrid operating room with Dyna-CT facilities.

Figure 3

Cardioscope: (A) the prototype of the cardioscope; (B) illustration of the design and bending flexible section; (C,D) cardioscope in ex vivo mock-up surgery; (E) images captured from cardioscope during pig pleurectomy.

Figure 4

Maneuvering of the wireless steerable endoscope system while suspended on an imitation chest wall: (A) adjustment of viewing direction in situ; (B) reposition by sliding movement.

Figure 5

Chest wall reconstruction by 3D printing of prosthesis. DICOM, digital imaging and communications in medicine; ROI, region of interest; STL, stereolithography.