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Thoracic Surgery: Current Practice and Future Directions: 2nd Edition
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Thoracic Surgery: Current Practice and Future Directions: 2nd Edition

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

Deadline for manuscript submissions: 15 June 2026 | Viewed by 1398

Special Issue Editor

Dr. Dania Nachira

E-Mail Website
Guest Editor
Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A. Gemelli", Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Interests: lung; lung cancer; lung diseases; thoracic diseases; malignant pleural effusion; mesothelioma; mediastinal diseases; thoracic surgery; bronchoscopy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

It is my pleasure to invite you to contribute to this Special Issue, entitled “Thoracic Surgery: Current Practice and Future Directions: 2nd Edition”. This is a new volume on the subject; we published 7 papers in the first edition of this Special Issue. For more details, please visit the following link: https://www.mdpi.com/journal/jcm/special_issues/T76E9W6998.

In the last few years, thoracic surgery has developed tremendously in terms of its use of new technologies, innovations in minimally invasive approaches, and integrated strategies for oncological treatments.

This Special Issue aims to collect new evidence on the safety, efficacy, and reproducibility of minimally invasive techniques, such as Uniportal-VATS and RATS, in lung, mediastinal, and esophageal diseases. It also aims to delve deeper into the results of new integrated oncological strategies, such as the role of immunotherapy in neoadjuvant therapy protocols.

This Special Issue will also look into innovative management in thoracic anesthesiology and loco-regional blocks for pain management during minimally invasive approaches.

Original research articles and reviews are welcome.

Their research areas may include (but are not limited to) the following:

  • Current evidence on NSCLC’s pathogenesis, modern strategies for integrated treatments, and future perspectives;
  • Novel endoscopic, diagnostic, and therapeutic techniques in thoracic surgery;
  • Minimally invasive thoracic surgery (VATS and RATS);
  • New anesthesiology and pain management strategies in thoracic surgery.

I look forward to receiving your contributions.

Dr. Dania Nachira
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • NSCLC
  • mediastinum
  • thymoma
  • esophageal disease
  • immunotherapy
  • new technologies
  • minimally invasive surgery
  • VATS
  • RATS

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Related Special Issue

Published Papers (3 papers)

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Research

14 pages, 1738 KB  
Article
Biportal-RATS vs. Uniportal-VATS for Lung Resections: A Propensity Score-Matched Analysis from Early Experience
by Dania Nachira, Khrystyna Kuzmych, Maria Teresa Congedo, Alessia Oddone, Giuseppe Calabrese, Alessia Senatore, Giovanni Punzo, Maria Letizia Vita, Leonardo Petracca-Ciavarella, Stefano Margaritora and Elisa Meacci
J. Clin. Med. 2025, 14(24), 8715; https://doi.org/10.3390/jcm14248715 - 9 Dec 2025
Viewed by 239
Abstract
Background/Objectives: Minimally invasive thoracic surgery has evolved rapidly, with uniportal video-assisted thoracoscopic surgery (U-VATS) and robotic-assisted thoracic surgery (RATS). Biportal-RATS (Bi-RATS) has emerged as a hybrid technique, combining robotics advantages with the reduced invasiveness of U-VATS. The aim of this study was [...] Read more.
Background/Objectives: Minimally invasive thoracic surgery has evolved rapidly, with uniportal video-assisted thoracoscopic surgery (U-VATS) and robotic-assisted thoracic surgery (RATS). Biportal-RATS (Bi-RATS) has emerged as a hybrid technique, combining robotics advantages with the reduced invasiveness of U-VATS. The aim of this study was to evaluate the safety, perioperative outcomes, lymphadenectomy, and postoperative quality of life (QoL) of Bi-RATS compared with U-VATS for lung resections. Methods: This single-center, observational cohort study included 130 consecutive patients undergoing anatomical lung resection between December 2021 and December 2024. Baseline and perioperative characteristics, including complications, chest drain duration, hospital stay, and lymph node yield, were analyzed. Health-related QoL was assessed preoperatively and 6 months postoperatively using the EQ-5D-5L questionnaire and EQ-VAS. Propensity score matching (PSM) at a 1:1 ratio was performed to minimize selection bias, obtaining 32 patients per group. Results: After PSM, the baseline characteristics were comparable between groups. Operative time was longer with Bi-RATS (221.3 ± 84.5 vs. 119.3 ± 53.4 min, p < 0.001). No significant differences were observed in postoperative complications, drain duration, or hospital stay. Bi-RATS seemed to be associated with a higher lymph node yield, particularly in segmentectomies. At 6 months, the overall EQ-VAS was comparable between techniques (78.9 U-VATS vs. 78.1 Bi-RATS; p = 0.832), while among the EQ-5D-5L dimensions, only mobility favored Bi-RATS (p = 0.045). Conclusions: Bi-RATS appears safe and effective, with perioperative outcomes and overall EQ-VAS comparable to those of U-VATS 6 months after surgery. These findings suggest that Bi-RATS may represent a valuable evolution of minimally invasive thoracic surgery. Full article
(This article belongs to the Special Issue Thoracic Surgery: Current Practice and Future Directions: 2nd Edition)
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14 pages, 1895 KB  
Article
Predicting Pneumothorax and Hemorrhage After CT-Guided Lung Biopsy: Role of Lesion Size, Depth and Their Interaction
by Rosa Alba Pugliesi, Andreas H. Mahnken, Nour Maalouf and Jonas Apitzsch
J. Clin. Med. 2025, 14(23), 8269; https://doi.org/10.3390/jcm14238269 - 21 Nov 2025
Viewed by 402
Abstract
Background/Objectives: CT-guided transthoracic lung biopsy is essential for diagnosing pulmonary lesions but poses risks, chiefly pulmonary hemorrhage and pneumothorax. Both complications can prolong hospitalization or require chest drainage. Emerging evidence suggests that hemorrhage along the biopsy tract may influence pneumothorax risk. This study [...] Read more.
Background/Objectives: CT-guided transthoracic lung biopsy is essential for diagnosing pulmonary lesions but poses risks, chiefly pulmonary hemorrhage and pneumothorax. Both complications can prolong hospitalization or require chest drainage. Emerging evidence suggests that hemorrhage along the biopsy tract may influence pneumothorax risk. This study aimed to evaluate lesion characteristics, tract hemorrhage, and their interaction as predictors of complications, as well as to explore predictive modeling approaches. Methods: In this retrospective single-center study, 118 patients (median age 69 years; 55.9% male) underwent CT-TTLB between January 2020 and April 2025. Multivariable logistic regression with Firth correction was used to identify predictors of hemorrhage and pneumothorax, including a lesion depth–hemorrhage interaction. Model discrimination was assessed via bootstrap-corrected ROC analysis. CART analysis defined lesion size thresholds associated with hemorrhage risk. Random Forest and XGBoost models were applied for exploratory comparison. Results: Hemorrhage occurred in 29.7% and pneumothorax in 22.0% of cases, with overlap in seven. Larger lesions were less likely to bleed (OR 0.96 per mm, p = 0.002), while deeper lesions increased pneumothorax risk (OR 1.06 per mm, p = 0.007). The depth–hemorrhage interaction suggested a possible mitigating effect of bleeding in deeper lesions; however, this was an exploratory observation and did not reach conventional statistical significance (p = 0.078). Conclusions: Limited tract hemorrhage may partially reduce pneumothorax risk in deeper lesions, but this finding is exploratory and requires prospective validation. Lesion size remains the primary determinant of bleeding, and CART-derived thresholds may inform individualized procedural planning and risk stratification. Full article
(This article belongs to the Special Issue Thoracic Surgery: Current Practice and Future Directions: 2nd Edition)
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19 pages, 1682 KB  
Article
The Stapler Dilemma in VATS Wedge Resection: Are Sutures a Viable Alternative?
by Mithat Fazlioglu, Argun Kıs, Gokhan Ozturk and Nevin Fazlioglu
J. Clin. Med. 2025, 14(20), 7356; https://doi.org/10.3390/jcm14207356 - 17 Oct 2025
Viewed by 542
Abstract
Background: This single-center, retrospective, non-randomized observational study aims to explore the outcomes of video-assisted thoracoscopic surgery (VATS) wedge resection using the traditional clamp-and-suture technique versus staplers, with a focus on cost-effectiveness, operative time, and short-term postoperative outcomes. Methods: Data from 59 patients who [...] Read more.
Background: This single-center, retrospective, non-randomized observational study aims to explore the outcomes of video-assisted thoracoscopic surgery (VATS) wedge resection using the traditional clamp-and-suture technique versus staplers, with a focus on cost-effectiveness, operative time, and short-term postoperative outcomes. Methods: Data from 59 patients who underwent VATS wedge resection between 2018 and 2024 were retrospectively analyzed. Patients were divided into the stapler group (S-group, n = 27) and the clamp-and-suture group (C-group, n = 32). Technique selection was made intraoperatively by the surgeon based on lesion characteristics. Co-primary outcomes were total hospitalization cost and air leak duration > 2 days. Secondary outcomes included drainage time, complications, and hospital stay. The researchers conducted multivariable regression and sensitivity analyses to handle selection bias and confounding variables. Statistical analyses were performed with a significance level of p < 0.05. This study was approved by the Tekirdağ University Faculty of Medicine Ethics Committee (Approval No: 2024.22.02.06). Results: The C-group lesions showed proximity to the pleural surface at 5 mm compared to 8 mm (p = 0.048), indicating significant selection bias. Operation time was longer in the C-group (70 vs. 60 min, p = 0.115). Air leak duration and drainage time were similar between groups (p = 0.872, p = 0.176). Complication rates classified by Clavien–Dindo scale and hospital stay were comparable. The C-group showed reduced hospitalization expenses ($191.6 vs. $371.7) after adjusting for lesion characteristics and confounders while the clinical results between groups remained equivalent (adjusted OR for air leak: 0.68, 95% CI: 0.13–3.51, p = 0.645). The cost advantages persisted through sensitivity analysis which tested for selection bias effects. Conclusions: The clamp-and-suture method appears to offer a potentially cost-effective alternative to staplers for carefully selected peripheral lesions in VATS wedge resection, particularly in resource-limited settings. The preliminary results need to be treated as speculative because the study uses a non-randomized retrospective design with limited data from a small number of patients treated by one surgeon and shows evidence of selection bias. The obtained results do not qualify as practice-changing recommendations. The validation of these findings requires prospective randomized controlled trials with predetermined selection criteria and extended follow-up periods to establish clinical recommendations. Full article
(This article belongs to the Special Issue Thoracic Surgery: Current Practice and Future Directions: 2nd Edition)
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