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Thoracic Surgery: Updates and New Trends
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Thoracic Surgery: Updates and New Trends

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Respiratory Medicine".

Deadline for manuscript submissions: 31 January 2026 | Viewed by 1375

Special Issue Editor

Dr. Monica Casiraghi

E-Mail Website
Guest Editor
1. Department of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy
2. Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
Interests: minimally invasive surgery; robotic surgery; lung cancer; mediastinal tumors; pleural tumors
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Thoracic surgery has significantly advanced in recent years, marked by the integration of cutting-edge technologies and innovative surgical techniques into both diagnosis and treatments. Minimally invasive procedures, such as robot-assisted thoracic surgery (RATS) and the Ion bronchoscopy procedure have become increasingly prevalent, allowing clinicians to identify and characterize very small nodules and then, in combination with robotic surgical systems, to achieve enhanced surgical precision and dexterity, leading to reduced postoperative pain, shorter hospital stays, and quicker recoveries. In addition, artificial intelligence (AI) and machine learning are proving to be transformative in thoracic surgery. These technologies facilitate surgical planning, intraoperative navigation, and postoperative outcome prediction. For instance, AI-driven video analysis assists in surgical phase recognition, enabling real-time decision support and skill assessment. Additionally, virtual reality (VR) is used for preoperative planning, allowing surgeons to simulate procedures and optimize strategies before entering the operating room.

Furthermore, the development of hybrid operating rooms has facilitated the combination of surgical and interventional procedures, enhancing the treatment of complex thoracic conditions.

Overall, the convergence of technological innovation and surgical expertise is propelling thoracic surgery into a new era, characterized by enhanced patient outcomes, increased procedural efficiency, and expanded therapeutic possibilities.

Dr. Monica Casiraghi
Guest Editor

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Keywords

  • minimally invasive surgery
  • new technology
  • diagnosis
  • bronchoscopy
  • robotic system
  • artificial intelligence

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Published Papers (2 papers)

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Research

16 pages, 544 KB  
Article
Thymectomy in Ocular Myasthenia Gravis: Results Before and After Generalization and Prognostic Predictors of Outcomes
by Dania Nachira, Maria Teresa Congedo, Khrystyna Kuzmych, Amelia Evoli, Raffaele Iorio, Maria Letizia Vita, Leonardo Petracca-Ciavarella, Adriana Nocera, Carolina Sassorossi, Jessica Evangelista, Paraskevas Lyberis, Giovanni Maria Comacchio, Jury Brandolini, Vittorio Aprile, Carmelina Cristina Zifara, Maria Giovanna Mastromarino, Alexandro Patirelis, Elena Asteggiano, Marco Anile, Federico Venuta, Andrea Imperatori, Vincenzo Ambrogi, Piergiorgio Solli, Andrea Dell’Amore, Marco Lucchi, Franca Melfi, Mohsen Ibrahim, Enrico Ruffini, Federico Rea, Stefano Margaritora and Elisa Meacciadd Show full author list remove Hide full author list
J. Clin. Med. 2025, 14(21), 7840; https://doi.org/10.3390/jcm14217840 (registering DOI) - 4 Nov 2025
Abstract
Background: The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. Methods: We conducted a multicenter retrospective study on 174 OMG patients who underwent thymectomy (112 OMG, 62 generalized OMG [g-OMG]). The primary endpoint was complete stable remission [...] Read more.
Background: The role of thymectomy in ocular myasthenia gravis (OMG) remains controversial, particularly before secondary generalization. Methods: We conducted a multicenter retrospective study on 174 OMG patients who underwent thymectomy (112 OMG, 62 generalized OMG [g-OMG]). The primary endpoint was complete stable remission (CSR; MGFA-PIS criteria). Multivariable analyses identified predictors of CSR and generalization. Results: Mean age at surgery was 42.3 ± 13.0 years; 53.4% were male. Thymoma was present in 29.3%. CSR was achieved in 18.9% overall, significantly higher in OMG (23.2%) compared to g-OMG (11.3%, p = 0.036), with 5-year CSR probabilities of 43% vs. 22% (p = 0.017). In non-thymomatous patients, 5-year CSR remained higher in OMG (41% vs. 17%, p = 0.010). Postoperative myasthenic crisis occurred exclusively in g-OMG (8.1%, p = 0.004). Multivariable analysis identified preoperative cholinesterase inhibitor monotherapy as an independent predictor of CSR (HR = 31.776, 95% CI: 4.188–241.111, p = 0.001; non-thymomatous: HR = 19.746, 95% CI: 2.518–154.849, p = 0.005). Minimally invasive techniques (78.6%) were associated with low morbidity (5.2%). Conclusions: Thymectomy during the purely ocular stage is associated with higher CSR rates and lower perioperative neurological risk than after generalization, particularly in non-thymomatous disease. Use of cholinesterase inhibitors as sole therapy prior to thymectomy independently predicts CSR. These findings support earlier surgical consideration in selected OMG patients and highlight the safety of minimally invasive approaches. Full article
(This article belongs to the Special Issue Thoracic Surgery: Updates and New Trends)
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12 pages, 614 KB  
Article
10-Year Long-Term Outcomes of Robotic-Assisted Segmentectomy for Early-Stage Non-Small-Cell Lung Cancer
by Monica Casiraghi, Riccardo Orlandi, Antonio Mazzella, Lara Girelli, Giovanni Caffarena, Matteo Chiari, Luca Bertolaccini, Giorgio Lo Iacono, Cristina Diotti, Claudia Bardoni, Patrick Maisonneuve and Lorenzo Spaggiari
J. Clin. Med. 2025, 14(16), 5608; https://doi.org/10.3390/jcm14165608 - 8 Aug 2025
Viewed by 1051
Abstract
Objectives: Robotic-assisted segmentectomy (RAS) has proven to be safe and feasible for early-stage lung cancer; nonetheless, its oncologic efficacy and long-term outcomes are still debated. We aimed to explore whether RAS could be an alternative to robotic-assisted lobectomy (RAL) in early-stage NSCLC, focusing [...] Read more.
Objectives: Robotic-assisted segmentectomy (RAS) has proven to be safe and feasible for early-stage lung cancer; nonetheless, its oncologic efficacy and long-term outcomes are still debated. We aimed to explore whether RAS could be an alternative to robotic-assisted lobectomy (RAL) in early-stage NSCLC, focusing on long-term outcomes such as 10-year cancer-specific survival (CSS), cumulative rate of relapse (RR), and local recurrence (LR). Methods: Patients undergoing RAS for early-stage NSCLC (clinical stage I) were analyzed from August 2007 to August 2023. A 1:3 propensity score-matched analysis was performed among patients undergoing RAL, based on demographic characteristics and pathological stage. Primary endpoints were CSS, RR, and LR. Results: A total of 40 patients undergoing RAS were retrospectively enrolled. After matching 120 patients undergoing RAL, no significant differences were found in postoperative complications, median operative time, or length of hospital stay. Patients undergoing RAS had comparable 10-year CSS (p = 0.90) and RR (p = 0.99) to those undergoing RAL, whereas 10-year of cumulative incidence of local recurrence (LR) was 11.0% (95% CI: 3.4–23.7%) for RAS patients and 2.8% (95% CI: 0.5–8.9%) for RAL patients (p = 0.08). Additionally, RAL provided a significantly higher number of N1 and N2 lymph node retrievals (p < 0.0001 and 0.06, respectively), as well as a higher number of N2 stations (p = 0.0001). Conclusions: Based on our experiences, even though RAS can ensure excellent long-term outcomes in selected cases of early-stage NSCLC, comparable to RAL, the local recurrence rate was higher in the RAS group. Full article
(This article belongs to the Special Issue Thoracic Surgery: Updates and New Trends)
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