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Thoracic Surgery: State of the Art and Future Directions
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Thoracic Surgery: State of the Art and Future Directions

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

Deadline for manuscript submissions: 20 September 2025 | Viewed by 759

Special Issue Editors

Prof. Dr. Ugo Cioffi

E-Mail Website
Guest Editor
Department of Surgery, University of Milan, 20122 Milano, Italy
Interests: training in surgery; AI in surgery; lung cancer
Dr. Marco Scarci

E-Mail Website
Guest Editor
Department of Thoracic Surgery, Imperial College NHS Healthcare Trust, London W12 0HS, UK
Interests: training in surgery; AI in surgery; lung cancer
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

In this Special Issue, we aim to bring together a prestigious panel of experts to cover all aspects of thoracic surgery practice, encompassing both benign and malignant pathologies.

Our experts will share their insight into the latest research into thoracic surgery, addressing areas of uncertainty and highlighting the latest evidence-based practice.

This Special Issue aims to be seen as an annual update for busy thoracic surgeons, residents, and fellows who do not attend meetings regularly.

The articles are structured in an easy-to-follow style and give practical “take-home messages” to guide and improve current surgical practice.

We hope you enjoy reading this Special Issue.

Prof. Dr. Ugo Cioffi
Dr. Marco Scarci
Guest Editors

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 100 words) can be sent to the Editorial Office for announcement on this website.

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

  • thoracic surgery
  • lung surgery
  • lung cancer
  • rib fractures
  • lung disease
  • pectus excavatum

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Published Papers (2 papers)

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Research

10 pages, 840 KB  
Article
First 50 Cases with the ION Robotic-Assisted Navigational Bronchoscopy System in Routine Clinical Use in Germany: The Bonn Experience
by Donatas Zalepugas, Dirk Skowasch, Philipp Feodorovici, Benedetta Bedetti, Philipp Schnorr, Carmen Pizarro, Verena Tischler, Jan Arensmeyer, Daniel Kuetting, Joachim Schmidt and Hruy Menghesha
J. Clin. Med. 2025, 14(17), 6155; https://doi.org/10.3390/jcm14176155 (registering DOI) - 31 Aug 2025
Abstract
Background: The diagnostic work-up of small peripheral pulmonary nodules (PPNs) is becoming increasingly important, especially in light of the upcoming lung cancer screening programs and recommendations in practice. The systematic clinical introduction of the ION robotic-assisted navigational bronchoscopy (RNB) system represents a significant [...] Read more.
Background: The diagnostic work-up of small peripheral pulmonary nodules (PPNs) is becoming increasingly important, especially in light of the upcoming lung cancer screening programs and recommendations in practice. The systematic clinical introduction of the ION robotic-assisted navigational bronchoscopy (RNB) system represents a significant innovation in Germany, whereas clinical experience in the United States has already yielded promising results. The objective of this study is to present the outcomes of the first 50 patients examined with the ION system at our institutions. Materials and Methods: This is a retrospective, single-center analysis. We included the first 50 consecutive patients who underwent diagnostic evaluation of pulmonary nodules using the ION-RNB system, either in the Department of Thoracic Surgery or the Department of Pulmonology. Results: A total of 50 patients were evaluated, including 24 from the Department of Thoracic Surgery and 26 from the Department of Pulmonology. The pulmonary nodules were found in the peripheral third of the lung in 74% of cases, in the middle third in 18% of cases, and in the central third in 8% of cases. The mean lesion size was 1.64 cm (±0.91 cm). In all, 84% of the nodules were solid, 4% were subsolid, and 12% presented as ground-glass opacities (GGOs). Cone beam computed tomography (CBCT) was used to confirm tool-in-lesion position in 68% of cases compared to C-arm fluoroscopy in 32%. Additionally, radial endobronchial ultrasound (rEBUS) was applied in 30% of procedures. The overall diagnostic yield, independent of imaging modality or histological processing method, was 78%. When CBCT and formalin-fixed paraffin-embedded (FFPE) histological analysis were utilized, the diagnostic yield exceeded 90%. Conclusions: Initial clinical experience with the ION-RNB system in Germany shows encouraging results. The high diagnostic accuracy underlines the system’s potential for evaluating peripheral pulmonary lesions precisely. The use of advanced imaging techniques, particularly CBCT, and the choice of histopathological processing methods are critical variables in optimizing patient-centered diagnostic pathways. Further prospective studies are warranted to assess the long-term clinical utility of robotic-assisted bronchoscopy in diverse clinical settings. Full article
(This article belongs to the Special Issue Thoracic Surgery: State of the Art and Future Directions)
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10 pages, 240 KB  
Article
Does the Use of Oral Nutritional Supplements Influence the Rate of Postoperative Complications After Uniportal Video-Assisted Thoracoscopic Lung Resection?
by Marco Andolfi, Michela Tiberi, Michele Salati, Marina Taus, Nadia Campelli, Francesco Xiumè, Alberto Roncon, Gian Marco Guiducci, Anna Chiara Nanto, Claudia Cola, Loris Angeli Temperoni and Majed Refai
J. Clin. Med. 2025, 14(12), 4226; https://doi.org/10.3390/jcm14124226 - 13 Jun 2025
Viewed by 479
Abstract
Background: The positive effects of oral nutritional supplements (ONS) on postoperative outcomes have been well recognized in several previous studies. However, to date, little data has been available with respect to determining the best immune modulating supplement to use and what its impact [...] Read more.
Background: The positive effects of oral nutritional supplements (ONS) on postoperative outcomes have been well recognized in several previous studies. However, to date, little data has been available with respect to determining the best immune modulating supplement to use and what its impact might be in thoracic surgery. The aim of this study was to evaluate the role of preoperative immune-nutritional supplement intake as predictor of postoperative cardiopulmonary complications (CPCs) in patients undergoing uniportal video-assisted thoracoscopic (uVATS) lung resection. Methods: This is a retrospective, observational study enrolling consecutive patients who underwent uVATS lung resections for cancer from January 2022 to December 2024 in the context of the Enhanced Pathway of Care (EPC) Program. All patients were evaluated by a nutritionist and dietetics team during the preoperative phase. The nutritional protocol consisted of 250 mL ONS rich in arginine, omega-3-fatty acids, and nucleotides to be taken twice a day for 5–7 days before surgery. Results: Four hundred ninety-one patients were enrolled: 277 patients underwent anatomic lung resection and 214 underwent wedge resection (WR). Utilizing the univariate analysis, we found that in patients undergoing anatomic lung resection, not-ONS-intake, high Body Mass Index (BMI), and arrythmia were correlated with a higher CPCs rate compared to the patients without nutritional supplementation (7.2% ONS vs. 15% not-ONS, p = 0.04; BMI 28.4 kg/m2 vs. BMI 26.4 kg/m2, p = 0.03; 31.2% arrythmia vs. 9.4% no-arrythmia, p < 0.01). These correlations, except for BMI, were confirmed after stepwise logistic regression. Alternately, in patients undergoing WR, hypertension and low-FEV1% were associated with a higher CPCs rate (5.1% hypertension vs. 0.4% no-hypertension, p = 0.02; FEV1% 79.7% vs. 95%, p = 0.01). Conclusions: Our results demonstrated that preoperative ONS after uVATS anatomic lung resection, in the context of an EPC program, influences the postoperative period, reducing the CPCs rate. Full article
(This article belongs to the Special Issue Thoracic Surgery: State of the Art and Future Directions)
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