Mitral valve replacement in a 23 year old East Timorese male patient. Mitral valve severely stenosed and regurgitant due to rheumatic valve disease. A 29mm Medtronic Mosaic porcine bioprosthesis implanted. Prosthesis kindly donated by Medtronic Australia. @MedtronicCardiac

Complex segmentectomy, left S9+10, showcasing the advantages of the DaVinci Xi robotic platform. Bimanual bipolar energy dissection of lung tissue, vessel seal extend bipolar diathermy device, tremendous magnification and great 3D optics, Firefly mode, complete control of camera and retraction of the lung, virtually zero blood loss, I could go on! Previously, I would have performed this as a superior segment / S6- sparing left lower lobectomy VATS. The early splitting of the S6 from S9+10 is useful because this patient had a incomplete fissure and fairly distal bifurcation of the A9+10 artery from the common basal artery.

We present an unedited (but sped up x2-x8) video of a robot assisted pulmonary bi-lobectomy (RUL & RML) for a 4.5cm peripheral tumour in the anterior segment of the RUL which directly invades the adjacent RML. The patient is a 76 year old otherwise well female with a biopsy proven adenocarcinoma of the lung. EBUS was performed pre-operatively to rule out N2 nodal involvement. The patient did well post-operatively, her drain tube was removed at 36 hours postop and she was discharged from hospital on the 3rd post-operative morning.

This video shows the utility of robotic surgery in performing precise dissection in difficult to access locations in the chest, in this case in the superior mediastinum in the region posterior and medial to the left subclavian artery. In addition to the subclavian artery, the oesophagus, left vagus nerve and thoracic duct are at risk in performing surgery at this location. This is a case of a 72 year old man with a history of a large cutaneous squamous cell cancer resected from the anterior chest wall 10 months previously.

This male patient in his early 60s presented with 3 months of worsening fatigue, anorexia, breathlessness and more recently, fevers. He was also investigated for new back pain and found to have vertebral discitis. Blood cultures were positive for enterococcus faecalis. Echocardiogram confirmed moderate to severe aortic and mitral regurgitation with multiple small sub-centimetre vegetations on the leaflets of both valves. The diagnosis of subacute bacterial endocarditis involving the aortic and mitral valves was made and he was started on intravenous antibiotics.

In this video we show our technique of systematic ymphadenectomy when performing right-sided lung cancer resection procedures using the Da Vinci Xi robotic surgical system. In order we perform: 1) release of the pulmonary ligament and clearance of station 9 nodes 2) clearance of station 8 nodes, followed by the subcarinal / station 7 nodes 3) dissection of the posterior aspect of the hilum with clearance of station 10R and 11R superior nodes, not shown in this video 4) dissection of the superior aspect of the hilum with clearance of 10R nodes 5) clearance of the 4R and 2R / paratracheal nodal region.

This is a short clip of a mitral valve replacement I recently performed on a 34 year old lady from East Timor who had severe regurgitation due to rheumatic valve disease. The cardiac surgery team at St John of God Geelong (SJOGG) Hospital had the privilege of assisting the East Timor Hearts Fund (ETHF) in providing treatment to the people of East Timor, where rheumatic heart disease is endemic. The ETHF is a remarkable volunteer organisation and charity which does great work in our neighbouring young nation of East Timor to prevent and treat heart disease.

Here we present a case of a 76 year old lady with a bronchial carcinoid tumour obstructing the common basal bronchus of the right lower lobe. She had a history of pleuro-pericarditis, and recurrent lung infections causing widespread pleural adhesions. She made an uncomplicated recovery and was discharged from hospital 3 days postoperatively.

This video shows a case of intralobar sequestration involving both the superior segment (S6) and the posterior basal (S10) segment of the left lower lobe. We used the Da Vinci Xi robotic surgical system to perform this surgery minimally invasively. The video magnification and fine agile instrumentation of the robotic system was ideal for this type of surgery. The patient made an uncomplicated recovery and was discharged how 4 days after surgery. When reviewed 2 weeks after surgery she had already returned to full activities and reported being pain-free and feeling well.

This female patient in her early 70s had a 2cm apical left upper lobe tumour with a 17mm FDG avid lymph node on the superior aspect of the lung hilum. It was unclear if this represented a station 10 or 5 lymph node. Regardless, the lung multidisciplinary meeting recommended she undergo surgical resection. At surgery the node in question was clearly a AP window (station 5) node. In addition, she had a mediastinal lingular artery, which is said to be present in up to 20% of patients. Her lung fissure was nearly absent. The patient was discharged from hospital on post-operative day 5 as she had a small air leak for the first 3 days.

63 yo lady, ex-smoker, with moderately severe airways disease, was found incidentally to have a 13mm intensely FDG-avid nodule in the lateral segment of the right lower lobe. An attempt at CT-guided needle biopsy was non-diagnostic. Spirometry: FEV1 1.38L, 49% predicted. She was obese. ECOG 1. We performed a sublobar resection given her limited lung reserve. She did well and was discharged home on the fourth post-operative day. Her final histopath revealed a adenocarcinoma of the lung with a maximum dimension of 23mm, T1cN0M0, with clear resection margins.

A part-solid lung nodule (PSN) or subsolid lung nodule is a morphological descriptor for a type of pulmonary nodule. It usually refers to a ground glass nodule with some solid component. They can be a manifestation of inflammation, infection, or fibrosis, but they can also be precursors of lung cancer, mainly adenocarcinoma (atypical adenomatous hyperplasia). Their overall malignant potential is considered higher than that of a comparatively size solid pulmonary nodule or a ground glass nodule. Notably, persistent lesions have a high likelihood of malignancy.

The harmonic blade facilitates easy atraumatic skeletonisation of the artery without the need to use any clips for the branches. The advantages of using a harmonic scalpel include: 1) a long conduit suitable for sequential and complex arterial grafting 2) minimising graft spasm from frequent handling of the graft or pinching of the body of the artery by side-branch vessel clips 3) reduction in collateral thermal injury to the chest wall and nearby vessels compared to diathermy harvest 4) faster conduit harvest 5) reduction in surgeon fatigue, as there is no need for frequent instrument exchanges required to clip and cut side branches

We present a case of a 67 year old man who was admitted to hospital 4 days after an episode of severe chest pain. His coronary angiogram showed occlusion of the distal right coronary artery consistent with a delayed presentation of an inferior AMI. He was then found to have loud murmur. Echocardiography showed a 17mm defect in the inferior-basal ventricular septum, establishing a diagnosis of post-MI VSD. He remained stable on medical treatment. Six weeks later we performed surgical repair of the VSD. This video shows the technique we used in this case. The patient went on to make a good recovery.

We present a case of extralobar pulmonary sequestration in a 20 year old male who presented with several days of pleuritic chest pain. He was found on imaging to have a moderate left pleural effusion. This was sampled and was noted to be heavily blood stained. He was taken to theatre for exploration of the left pleural space using the Da Vinci Xi robotic surgical system.

This patient had an enlarging 8mm indeterminate pulmonary nodule deep within the posterior segment (S2) of the right upper lobe. We performed a robot-assisted segmentectomy using the Da Vinci Xi robotic surgical system. After the broncho-vascular structures were divided indocyanine green was injected systemically in order to delineate the inter-segmental parenchymal borders. The patient made an uneventful recovery and was discharged home on the third post-operative day. The nodule turned out to be an inflammatory lesion.

74 year old lady with a asymptomatic incidentally discovered persistent right upper lobe lung 3.5cm spiculated lesion with mild FDG PET uptake. She opted for surgical resection following a period of observation over 6 months. This is an unedited video. We have sped up the video x2 as a minimum. and at times x4 and x8, to improve its watchability. We believe an unedited video has added value over and above a heavily edited video as the audience can observe the uncertainties and inefficiencies, and even the errors, in the conduct of the surgery.

This lady had a 3cm tumour of the lung within the middle lobe (ML). It had a large semisolid component that occupied most of the inferior half of the lobe. We removed the ML using the Da Vinci Xi robotic surgical system. She made an uncomplicated recovery and was discharged home on the second post-operative day. Histopathological examination revealed a adenocarcinoma of the lung with a large lepidic component. There was no evidence of nodal involvement. Surgical margins were clear.

Emergency open repair of an acute type A dissection: 1. aortic root replacement with a mechanical valved conduit 2. replacement of the ascending aorta 3. Cabrol graft reconstruction go the left main coronary artery / ostia. There was a slightly unusual location of the primary entry tear at the left main coronary ostia, within the aortic root.

This was an invited presentation given by Dr Cheng-Hon Yap at the recent ISMICS workshop along with the 5th Annual Conference of the Society of Minimally Invasive Cardiovascular & Thoracic Surgeons of India (Hybrid Edition) 24-25 September 2021. The Cor-Knot device is a piece of equipment that removes the need to create suture knots when implanting a conventional surgical aortic valve prosthesis. It fires a titanium fastener which reliably secures the sutures.