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New Trends in Minimally Invasive Thoracic Surgery
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New Trends in Minimally Invasive Thoracic Surgery

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

Deadline for manuscript submissions: 28 August 2025 | Viewed by 2263

Special Issue Editors

Dr. Maria Letizia Vita

E-Mail Website
Guest Editor
Department of General Thoracic Surgery, Fondazione Policlinico Gemelli IRCCS, Catholic University of Sacred Heart of Rome, 00168 Rome, Italy
Interests: lung cancer; U-VATS; thymoma; mediastinal diseases; esophageal cancer
Dr. Leonardo Petracca Ciavarella

E-Mail Website
Guest Editor
Department of Thoracic Surgery, Fondazione Policlinico Universitario “A.Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
Interests: lung cancer; U-VATS; thymoma; mediastinal diseases; esophageal cancer
Dr. Alberto Biondi

E-Mail Website
Guest Editor
Department of General Surgery, Università Cattolica Sacro Cuore, Rome, Italy
Interests: minimally invasive esophageal surgery; colorectal surgery; general surgery

Special Issue Information

Dear Colleagues,

Minimally invasive thoracic surgery was performed for the first time in 1910 by Jacobaeus; however, it only gained popularity in the 90s. 

Twenty years after the first-described VATS lobectomy, with the development of endoscopic instrumentation, uniportal VATS has emerged as a more minimally invasive procedure performed through a single incision. Uniportal VATS is now considered a favorable alternative in many thoracic procedures compared to traditional VATS and open thoracotomy, because it reduces the number of incisions and post-operative recovery.

Nowadays, with the increase in the employment of uniportal VATS, new techniques of loco-regional analgesia (echo-guided fascial plane blocks) have been proposed, creating the so-called “awake thoracic surgery”. This innovative approach has allowed for the inclusion of many patients that were not considered suitable for thoracic surgery until today.

Uniportal VATS seems to be a safe, feasible and effective technique also in esophageal surgery, and at our center, McKeown esophagectomy is performed with equivalent surgical and long-term oncological results as the standard thoracotomy, but with a faster recovery.

Endoscopic procedures reshaped thoracic surgery, but VATS can still improve. Site of incision (sub-xiphoid) and the use of 3D-video-camera- and navigation-guided uniportal VATS are some of the many others promising techniques that can potentially rewrite minimally invasive thoracic surgery.

Within this Special Issue of the Journal of Clinical Medicine, we invite you to show both the results of your research confirming the efficacy of VATS, and also new procedures that can increase the efficacy of minimally invasive thoracic surgery.

Dr. Maria Letizia Vita
Dr. Leonardo Petracca Ciavarella
Dr. Alberto Biondi
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
  • minimally invasive surgery
  • VATS
  • awake surgery
  • esophageal cancer

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Published Papers (3 papers)

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Research

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12 pages, 2394 KiB  
Article
Predictors of Compensatory Sweating and Satisfaction Following Endoscopic Thoracic Sympathetic Chain Clipping for Palmar/Axillary Hyperhidrosis
by Dania Nachira, Maria Letizia Vita, Antonio Giulio Napolitano, Adriana Nocera, Maria Teresa Congedo, Giovanni Punzo, Leonardo Petracca Ciavarella, Elisa Meacci and Stefano Margaritora
J. Clin. Med. 2025, 14(2), 326; https://doi.org/10.3390/jcm14020326 - 8 Jan 2025
Viewed by 856
Abstract
Background: Endoscopic thoracic sympathetic chain clipping (ETSC) is a definitive treatment for primary palmar and/or axillary hyperhidrosis (PPAH); however, compensatory sweating (CS) remains a feared complication. The aims of this study were to investigate the factors associated with CS and satisfaction with [...] Read more.
Background: Endoscopic thoracic sympathetic chain clipping (ETSC) is a definitive treatment for primary palmar and/or axillary hyperhidrosis (PPAH); however, compensatory sweating (CS) remains a feared complication. The aims of this study were to investigate the factors associated with CS and satisfaction with the treatment and to evaluate the post-operative quality of life (QoL). Methods: From January 2011 to August 2023, 180 patients who had undergone two-stage ETSC were prospectively asked to complete pre- and post-operative questionnaires on satisfaction, CS, and QoL in several daily activities. Results: Seventy-nine patients (45.7%) were male, and fifty-two (30.1%) were active smokers, with a mean body max index (BMI) of 22.6 ± 3.14. The majority of the population (112 (62.2%)) was operated on for combined palmar and axillary primary hyperhidrosis (PH), whereas 56 (31.1%) patients had only palmar and 12 (6.7%) only axillar PH. Only 122 (67.8%) patients completed ETSC on both sides and the follow-up in the study period. CS was 50.8% (62 patients), and there was severe CS in 7 cases (5.7%); 9 (7.4%) patients developed a gustatory CS. The final effectiveness of ETSC was 95.9%, with a reported improvement in QoL in 95.3% of cases (mainly in manual work and socialization); 94.1% of patients were satisfied and would undertake ETSC again. At multivariable analysis, only older age (>24 years) was a predictor of CS (p = 0.007) and severe CS (p = 0.042). No predictor for satisfaction was found. Conclusions: ETS by clipping can improve QoL in cases of palmar/axillary hyperhidrosis. Older patients must be informed of a higher risk of CS. Full article
(This article belongs to the Special Issue New Trends in Minimally Invasive Thoracic Surgery)
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Review

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11 pages, 224 KiB  
Review
New Trends in Uniportal Video-Assisted Thoracoscopic Surgery for Primary Spontaneous Pneumothorax: A Narrative Review
by Kenji Tsuboshima, Masatoshi Kurihara and Kota Ohashi
J. Clin. Med. 2025, 14(6), 1849; https://doi.org/10.3390/jcm14061849 - 9 Mar 2025
Viewed by 739
Abstract
Background: Minimally invasive thoracic surgery has advanced since the introduction of multiportal video-assisted thoracoscopic surgery (mVATS) in 1991. Primary spontaneous pneumothorax (PSP) is an ideal condition for refining minimally invasive techniques owing to its straightforward procedures and predictable bullae distributions. Methods: Uniportal VATS [...] Read more.
Background: Minimally invasive thoracic surgery has advanced since the introduction of multiportal video-assisted thoracoscopic surgery (mVATS) in 1991. Primary spontaneous pneumothorax (PSP) is an ideal condition for refining minimally invasive techniques owing to its straightforward procedures and predictable bullae distributions. Methods: Uniportal VATS (uVATS), which involves a single incision, is an alternative to mVATS, offering reduced postoperative pain, lower paresthesia rates, and comparable recurrence outcomes. This review explores two main uVATS approaches: intercostal and subxiphoid. Results: The intercostal approach is common to surgeons trained in mVATS, easier to adopt, and provides excellent cosmetic outcomes. Innovations such as the chest wall pulley method and anchoring sutures further enhance its operability and prevent recurrence. Subxiphoid uVATS minimizes intercostal nerve damage and postoperative pain, making it advantageous for bilateral PSP surgeries. However, it poses challenges such as longer operative times and limited dorsal visualization. Emerging strategies, including drainless postoperative management and two-lung ventilation with CO2 insufflation, have reduced surgical invasiveness. Additionally, cosmetic techniques such as subaxillary incisions enhance patient satisfaction. Conclusions: uVATS continues to redefine PSP surgery, prioritize patient-centered outcomes, and integrate novel strategies to achieve superior results. Full article
(This article belongs to the Special Issue New Trends in Minimally Invasive Thoracic Surgery)

Other

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44 pages, 2395 KiB  
Systematic Review
Artificial Intelligence in Thoracic Surgery: A Review Bridging Innovation and Clinical Practice for the Next Generation of Surgical Care
by Vasileios Leivaditis, Andreas Antonios Maniatopoulos, Henning Lausberg, Francesk Mulita, Athanasios Papatriantafyllou, Elias Liolis, Eleftherios Beltsios, Antonis Adamou, Nikolaos Kontodimopoulos and Manfred Dahm
J. Clin. Med. 2025, 14(8), 2729; https://doi.org/10.3390/jcm14082729 - 16 Apr 2025
Viewed by 464
Abstract
Background: Artificial intelligence (AI) is rapidly transforming thoracic surgery by enhancing diagnostic accuracy, surgical precision, intraoperative guidance, and postoperative management. AI-driven technologies, including machine learning (ML), deep learning, computer vision, and robotic-assisted surgery, have the potential to optimize clinical workflows and improve patient [...] Read more.
Background: Artificial intelligence (AI) is rapidly transforming thoracic surgery by enhancing diagnostic accuracy, surgical precision, intraoperative guidance, and postoperative management. AI-driven technologies, including machine learning (ML), deep learning, computer vision, and robotic-assisted surgery, have the potential to optimize clinical workflows and improve patient outcomes. However, challenges such as data integration, ethical concerns, and regulatory barriers must be addressed to ensure AI’s safe and effective implementation. This review aims to analyze the current applications, benefits, limitations, and future directions of AI in thoracic surgery. Methods: This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed using PubMed, Scopus, Web of Science, and Cochrane Library for studies published up to January 2025. Relevant articles were selected based on predefined inclusion and exclusion criteria, focusing on AI applications in thoracic surgery, including diagnostics, robotic-assisted surgery, intraoperative guidance, and postoperative care. A risk of bias assessment was conducted using the Cochrane Risk of Bias Tool and ROBINS-I for non-randomized studies. Results: Out of 279 identified studies, 36 met the inclusion criteria for qualitative synthesis, highlighting AI’s growing role in diagnostic accuracy, surgical precision, intraoperative guidance, and postoperative care in thoracic surgery. AI-driven imaging analysis and radiomics have improved pulmonary nodule detection, lung cancer classification, and lymph node metastasis prediction, while robotic-assisted thoracic surgery (RATS) has enhanced surgical accuracy, reduced operative times, and improved recovery rates. Intraoperatively, AI-powered image-guided navigation, augmented reality (AR), and real-time decision-support systems have optimized surgical planning and safety. Postoperatively, AI-driven predictive models and wearable monitoring devices have enabled early complication detection and improved patient follow-up. However, challenges remain, including algorithmic biases, a lack of multicenter validation, high implementation costs, and ethical concerns regarding data security and clinical accountability. Despite these limitations, AI has shown significant potential to enhance surgical outcomes, requiring further research and standardized validation for widespread adoption. Conclusions: AI is poised to revolutionize thoracic surgery by enhancing decision-making, improving patient outcomes, and optimizing surgical workflows. However, widespread adoption requires addressing key limitations through multicenter validation studies, standardized AI frameworks, and ethical AI governance. Future research should focus on digital twin technology, federated learning, and explainable AI (XAI) to improve AI interpretability, reliability, and accessibility. With continued advancements and responsible integration, AI will play a pivotal role in shaping the next generation of precision thoracic surgery. Full article
(This article belongs to the Special Issue New Trends in Minimally Invasive Thoracic Surgery)
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