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