Emerging technologies will change the way we practise surgery in the not-too-distant future. Minimal access thoracic surgery is an example of how technologic advances are making an impact on the performance of thoracic operations. Current editions of thoracic surgical textbooks contain little information on this emerging technology; often, journal reports are presented to show that a minimally invasive thoracic procedure is possible, but there is little discussion as to whether the procedure should be done by this technique.
This book is a well-written synthesis of current experience with new minimally invasive techniques in cardiothoracic surgery. Enough technical detail is included for an experienced thoracic surgeon to expand his repertoire of operations. I believe that the strength of this book, in addition to the technical detail, lies in the reasoned discussion of the context in which the procedures should be done. There is an admirable display of restraint, which is sometimes lacking in journal articles demonstrating a particular surgeon’s success with and enthusiasm for a particular technique.
Although this text is primarily for thoracic surgeons, it will also be of interest to those who are curious about future options for treatment in thoracic surgery. It is also useful for decision-makers and health administrators, who will find the balanced discussions of this new technology, which has budgetary implications, quite helpful.
The 18 chapters making up the book are remarkably uniform in approach and quality despite having been written by 22 contributors from 7 countries. Following introductory chapters on history, anatomy, anesthesia and instrumentation, there are chapters on surgery of the esophagus, lung, mediastinum, pleura and heart. Other chapters cover sympathectomy and vagotomy, oncology, palliation, complications and future trends. The descriptions vary from the fairly standard apical resection for pneumothorax to esophagectomy and major lung resections and even cardiac valve replacement. Each chapter is written by surgeons with extensive experience in their areas.
I found the information generally useful and helpful in evaluating the potential for adopting certain procedures. Far from being esoteric, the material covered broadens the reader’s appreciation of the possible applications of these techniques, from staging to minor thoracic procedures and to more complex operations.
On the negative side, the chapter on video-assisted surgery for pneumothorax was overly complicated and confusing. Pneumothorax in young, healthy people was not differentiated clearly from that occurring in elderly emphysematous patients. The suggested thoracoscopy under local anesthesia and computed tomography for uncomplicated pneumothorax is not a common practice and in my opinion is unnecessary.
I believe this book is valuable in that it covers a fast-breaking field in which thoughtful, reflective commentary is lacking, and it should be a welcome addition to any thoracic surgeon’s book collection.