Program Characteristics of Cardiothoracic Surgery Departments Versus Divisions

Background:The organizational structure of cardiothoracic surgery practices varies among different programs throughout the United States (U.S.). We aimed to investigate the characteristics of the top ranked programs within the specialty and the surgeons practicing within each.Methods: The top 50 hospitals for adult cardiology and heart surgery were identified using the US News and World Report 2019-20 ranking. There were 590 hospitals reported on, with 50 top rated programs. Data was collected from each hospital’s website, analyses conducted using SAS 9.4 with statistical significance set at p < 0.05. Results:When comparing cardiothoracic surgery program organizational structures, 21 of the top 50 ranked programs were departments and 24 were divisions within their respective Department of Surgery. Mean number of surgeons was 11 with no statistical difference when analyzed by division versus department. Overall, 9% of practicing cardiothoracic surgeons were female. Between programs that are a department versus division, general thoracic surgery was included in 58% of divisions and 52% of departments (p = ns). Among programs that were departments, approximately 6% of surgeons had attained a Ph.D., while in divisions approximately 4% of surgeons had attained a Ph.D. Conclusions:The top 50 Cardiothoracic Surgery programs in the U.S. have approximately the same number of surgeons within the group and are organized similarly. This study group had a slightly higher percentage of female surgeons than previously noted in cardiothoracic surgery, with general thoracic surgery trending toward higher gender diversity. The presence of physician scientists was low, though similar amongst the study groups.

An improved method of anchoring chest drain and suture technique for Uni-portal VATS incision

Uni-portal video-assisted thoracoscopic approach is currently a popular surgical technique in general thoracic surgery. After operation, a chest tube is usually placed through the incision to drain the effusion and gas from the thoracic cavity. In the conventional method, the retaining stitches should be taken out ten days after removing chest drain. To get better would-healing and avoid unsightly scar, we explored a method of anchoring chest drain and two-layer suture for Uni-portal incision without removing stitches post operation.

Construction of a computational mechanical model of bronchi for practical simulation of the optimal positive intrathoracic pressure conditions during general thoracic surgery

BACKGROUND: Thoracic CO2 insufflation with positive intrathoracic pressure is usually effective during thoracoscopic surgery, however, lung collapse is sometimes insufficient. We hypothesized that inappropriate bronchial collapse might cause this unsuccessful lung collapse. OBJECTIVE: The objective of this study was to construct a computational mechanical model of bronchi for practical simulation to discover the optimal conditions of positive intrathoracic pressure during thoracoscopic surgery. METHODS: Micro-focus high-resolution X-ray computed tomography measurements of lungs from just-slaughtered swine were extracted, and the three-dimensional geometries of the bronchi under pressurized and depressurized conditions were measured accurately. The mechanical properties of the bronchus were also measured. Computational fluid dynamics (CFD) and computational structural mechanics (CSM) analyses were conducted. RESULTS: The CSM results indicated that the present structural model could simulate bronchial occlusion. The CFD results showed that airflows from pressed lung alveoli might cause low-internal-pressure regions when suddenly or heterogeneously pushed airflow was injected from a small branching bronchus to a large bronchus. A preliminary computational mechanical model of bronchi was constructed. CONCLUSIONS: We demonstrated the performance of the mechanical model of bronchi in rough simulations of bronchial occlusions. However, this model should be verified further using human data to facilitate its introduction to clinical use.