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Down Gullet Alley
Lo and behold: The esophagus is here to stay! An analysis of the papers driving the 2019 Journal Impact Factor revealed two How-to-do-its on modern techniques in esophageal surgery published in 2018 ranking fourth and sixth of the most cited items.  This can be regarded as a proof of concept because several years ago the Editor had decided to cover and foster this subject again after years of relative negligence. Since then about one issue per year has sported the gullet as headline of the thoracic part.
One will always be affected by history, and hopefully for the better. Just look at this reference by Borst, Dragojevic, Stegmann and Hetzer, and be impressed to find the names of three surgeons much better known for their cardiac endeavors discussing unpleasant complications of esophageal resections troubling us to this very day. More than four decades later this kind of surgery has come a long way. It is an impressive example how advances in technology can serve to minimize surgical trauma and to reduce the immense morbidity these operations were afflicted with in the past. And the aficionados promise more to come, taking advantage of Artificial Intelligence and the like. It looks like there is a very brave new world on the horizon.
On the cardiac side of things similar achievements are seen in minimally invasive AV valve repair utilizing endoscopic techniques, in limited access aortic valve replacement, and in various forms of MIDCAB/OPCAB surgery. Again, the major aim is to reduce the surgical insult the patient's body has to bear. Young and aspiring surgeons would do well to concentrate on learning and further developing these approaches, because patient groups treated that way should really be the appropriate matches for catheter-based interventions and comparative studies. An anatomical repair of a regurgitant mitral or tricuspid valve will always be a causally determined therapy correcting the pathology, not substituting it for a different one as the edge-to-edge procedures do. The patient, however, must be given a chance to tolerate it. Minimizing access and limiting physical trauma is one side of the medal. The pathophysiology of extracorporeal circulation is the other one. Once again we have come a long way since the days of the bubble oxygenator but we haven't arrived yet by far. Looking for a research project to get your PhD? Acquaint yourself with the depths of the good old heart-lung-machine and you will come to realize that there is still a myriad of unanswered questions associated with it. But this will be the subject of another ThCVS issue.
Meanwhile keeping one's eyes open and considering how to implement achievements in other disciplines into one's own should be the way to success and better therapies for our patients. This journal will continue building the necessary bridges.
12 April 2021 (online)
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- 1 Grimminger PP, Hadzijusufovic E, Ruurda JPH, Lang H, van Hillegersberg R. The da Vinci Xi Robotic Four-Arm Approach for Robotic-Assisted Minimally Invasive Esophagectomy. Thorac Cardiovasc Surg 2018; 66 (05) 407-409
- 2 Grimminger PP, Hadzijusufovic E, Lang H. Robotic-Assisted Ivor Lewis Esophagectomy (RAMIE) with a Standardized Intrathoracic Circular End-to-side Stapled Anastomosis and a Team of Two (Surgeon and Assistant Only). Thorac Cardiovasc Surg 2018; 66 (05) 404-406
- 3 Heinemann MK. Swallow your pride. Thorac Cardiovasc Surg 2013; 61 (06) 459
- 4 Borst HG, Dragojevic D, Stegmann T, Hetzer R. Anastomotic leakage, stenosis, and reflux after esophageal replacement. World J Surg 1978; 2 (06) 861-864