The Future of Thoracic Surgery
Shari L. Meyerson, M.D.
Associate Professor of Surgery
Northwestern University
VATS RATS
Circulation management
Anesthesia
Staplers
Video capability
Disclaimer
The majority of what I am about to discuss is either experimental,
in clinical trials, or not yet approved for use in patients.
This is the future people!
Do not try this at home!
Esophageal Disease
Early Stage Esophageal CancerEsophagectomy→ Endoscopic Resection
AchalasiaLaparoscopic Heller Myotomy→ POEM
GERDLaparoscopic Nissen Fundoplication → LINX
Endoscopic Mucosal Resection
abdominalkey.com
Endoscopic Submucosal Dissection
abdominalkey.com
Laparoscopic Heller Myotomy
Boeckxstaens GE, 2014, Lancet
Per-Oral Endoscopic Myotomy
Teitelbaum EN, 2018, Lancet Gastroenterology & Hepatology
Per-Oral Endoscopic Myotomy
Bechara R, 2015, Nature Reviews, Gastroenterology & Hepatology
Nissen Fundoplication
www.tlcreflux.com
LINX
http://www.toraxmedical.com/linx/
Lung Cancer
Identifying Small NodulesAnatomic Triangulation → Physical or Liquid Markers
Lung MetastasesResection → Isolated Lung Perfusion
Lung Cancer StagingComplete Lymphadenectomy → Sentinel Lymph Node
Mapping with Nanoparticles
Physical Markers
Hook wire Coils
Huang HZ, 2017, Oncotarget
Liquid Markers
Mayoclinic.orgHan KN, 2017, ISMICS
Methylene Blue Indocyanine Green
Surgical Resection of Metastases
Factors Predicting Survival
Disease typeNumber of nodules
Disease-free intervalComplete resection
In Vivo Lung Perfusion
Delivers high dose chemo agents directly to tumor
Limits systemic toxicity
Need to evolve minimally invasive approaches
Cypel M, 2016, Thoracic Surgery Clinics
Nanotechnology
Diagnosis
Lymphatic Mapping
Smart Drug Delivery
Intraoperative Localization
Digesu CS, 2016, Thoracic Surgery Clinics
Targeted Drug Delivery
Lung Failure
COPDLVRS → Endoscopic Lung Volume Reduction
Lung TransplantStandard Donor Procurement → EVLP
End Stage Lung DiseaseTransplantation → Bioengineered Lung Tissue
Lung Volume Reduction Surgery
lung.templehealth.org/patient-care/treatments-services/lung-volume-reduction-surgery-lvrs
Intrabronchial Valves
Spiration Valve, Olympus
Endobronchial Valves
Zephyr Valve, Pulmonx
Valves in Situ
Lung Transplantation
Mayoclinic.org
Donor Procurement
www.omixon.com/one-donor-can-save-eight-lives/
Ex Vivo Lung Perfusion
Munshi L, 2013, Lancet
Bioengineered Lungs
Colvin KL, 2015, Frontiers in Pediatrics
Bioengineered Lungs
http://content.time.com/time/specials/packages/article/0,28804,2029497_2030617_2029715,00.html