Background: Patients sustaining multiple rib fractures have a significant risk of developing morbidity and mortality. More evidence is emerging that the indication of surgical stabilization of rib fractures (SSRF) should expand beyond flail chest. Nevertheless, little is known about factors associated with poor outcomes after surgical fixation. We reviewed patients with rib fractures to further explore the role of SSRF; we matched two groups by propensity score (PS). Method: A comparison of patients with blunt thoracic trauma treated with SSRF between 2010 and 2020 was compared with those who received conservative treatment for rib fractures. Risk factors for poor outcomes were analyzed by multivariate regression analysis. Results: After tailored SSRF, the number of fractured ribs was not associated with longer ventilator days (p = 0.617), ICU stay (p = 0.478), hospital stay (p = 0.706), and increased nonprocedure-related pulmonary complications (NPRCs) (p = 0.226) despite having experienced much more severe trauma. In the multivariate regression models, lower GCS, delayed surgery, thoracotomy, and flail chest requiring mechanical ventilation were factors associated with prolonged ventilator days. Lower GCS, higher ISS, delayed surgery, and flail chest requiring mechanical ventilation were factors associated with longer ICU stays. Lower GCS and older age were factors associated with increased NPRCs. In the PS model, NPRCs risk was reduced by SSRF. Conclusions: The risk of NPRCs was reduced once ribs were surgically fixed through an algorithmic approach, and poor consciousness and aging were independent risk factors for NPRCs.

Following surgery, perioperative pulmonary rehabilitation (PR) is important for patients with early-stage lung cancer. However, current inpatient programs are often limited in time and space, and outpatient settings have access barriers. Therefore, we aimed to develop a background-free, zero-contact thoracoabdominal movement-tracking model that is easily set up and incorporated into a pre-existing PR program or extended to home-based rehabilitation and remote monitoring. We validated its effectiveness in providing preclinical real-time RGB-D (colour-depth camera) visual feedback. Twelve healthy volunteers performed deep breathing exercises following audio instruction for three cycles, followed by audio instruction and real-time visual feedback for another three cycles. In the visual feedback system, we used a RealSense™ D415 camera to capture RGB and depth images for human pose-estimation with Google MediaPipe. Target-tracking regions were defined based on the relative position of detected joints. The processed depth information of the tracking regions was visualised on a screen as a motion bar to provide real-time visual feedback of breathing intensity. Pulmonary function was simultaneously recorded using spirometric measurements, and changes in pulmonary volume were derived from respiratory airflow signals. Our movement-tracking model showed a very strong correlation (r = 0.90 ± 0.05) between thoracic motion signals and spirometric volume, and a strong correlation (r = 0.73 ± 0.22) between abdominal signals and spirometric volume. Displacement of the chest wall was enhanced by RGB-D visual feedback (23 vs 20 mm, P = 0.034), and accompanied by an increased lung volume (2.58 vs 2.30 L, P = 0.003). We developed an easily implemented thoracoabdominal movement-tracking model and reported the positive impact of real-time RGB-D visual feedback on self-promoted external chest wall expansion, accompanied by increased internal lung volumes. This system can be extended to home-based PR.

Thoracic injuries, especially rib fractures, carry high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) has emerged as a promising approach to reduce pulmonary complications. We aimed to analyze the benefits of SSRF beyond flail chest and make the study applicable to clinical practice. This study compared SSRF and conservative treatments at a tertiary trauma center. A time series analysis and propensity score matching were applied to evaluate the outcomes. Data from a trauma registry (January 2017 to December 2020) were used. Exclusion criteria included patients with non-salvageable injuries and those transferred after 72 h. Primary outcomes were ventilator-free days on day 28 (VFD28) and non-procedural pulmonary complications (NPRCs). Of 770 eligible patients, 692 were enrolled, with 164 undergoing SSRF. SSRF patients had significantly longer VFD28 (22.5 vs. 19.0; P = 0.042) and reduced NPRCs (8.0 % vs. 14.5 %; P = 0.086). Subgroup analysis showed that SSRF patients requiring mechanical ventilation had longer ICU-free days (IFD28) and hospital-free days (HFD90) and lower mortality rates. Those not receiving ventilation but with more than three rib fractures also benefited from SSRF in terms of reduced NPRCs. SSRF improved clinical outcomes in more than just flail chest cases, benefiting patients with multiple rib fractures, both with and without mechanical ventilation. These findings support the broader clinical application of SSRF.

Background/Purpose Robotic-assisted thoracoscopic surgery (RATS) has increasingly been adopted in thoracic surgery, yet direct comparisons with uniportal video-assisted thoracoscopic surgery (uVATS) for complex segmentectomy remain limited. We compared early perioperative outcomes between RATS and uVATS for complex pulmonary segmentectomy. Methods Patients undergoing complex segmentectomy between 2023 and 2025 were reviewed. Complex segmentectomy was defined as resection of any segment other than the bilateral superior segment of the lower lobes, lingular, or superior segment of the left upper lobe. After the RATS learning curve, a 1:1 propensity score matching was performed based on age, sex, ASA classification, BMI, and specific segmentectomy procedures, yielding 81 matched pairs in each group. Results RATS was associated with a significantly longer skin-to-skin operative time (133 vs. 92 min; P < 0.001) and higher self-paid costs (USD 5,899 vs. 2,557; P < 0.001). Chest drainage duration and length of hospital stay were comparable between the groups. Major morbidity occurred less frequently in the RATS group (0.0% vs. 7.4%; P = 0.031), although prolonged air leak itself did not significantly differ between groups (0.0% vs. 6.2%; P = 0.063). RATS was also associated with greater N2 nodal dissection and a higher number of lymph nodes retrieved (median 7 vs. 2; P < 0.001). No conversions or in-hospital mortality occurred. Conclusion RATS provides comparable short-term safety for complex segmentectomy. Although it is associated with longer operative time and increased financial burden, RATS may offer potential advantages in reducing major morbidity. These findings support the selective use of RATS for anatomically complex or high-risk cases. Further studies should assess long-term oncologic outcomes and cost-effectiveness.

We report an angiographic image of a 58-year-old woman with profuse bleeding from a tracheo-innominate artery fistula. It may not have been possible to obtain this valuable image if adequate initial resuscitation and an over-inflated tracheostomy tube cuff had not been administered to stop bleeding during an emergency.

High-grade liver laceration is a common injury with bleeding as the main cause of death. Timely resuscitation and hemostasis are keys to the successful management. The impact of in-hospital trauma system on the quality of resuscitation and management in patients with traumatic high-grade liver laceration, however, was rarely reported. We retrospectively reviewed the impact of team-based approach on the quality and outcomes of high-grade traumatic liver laceration in our hospital. Patients with traumatic liver laceration between 2002 and 2020 were enrolled in this retrospective study. Inverse probability of treatment weighting (IPTW)-adjusted analysis using the propensity score were performed. Outcomes before the trauma team establishment (PTTE) and after the trauma team establishment (TTE) were compared. A total of 270 patients with liver trauma were included. After IPTW adjustment, interval between emergency department arrival and managements was shortened in the TTE group with a median of 11 min (p < 0.001) and 28 min (p < 0.001) in blood test reports and duration to CT scan, respectively. Duration to hemostatic treatments in the TTE group was also shorter by a median of 94 min in patients receiving embolization (p = 0.012) and 50 min in those undergoing surgery (p = 0.021). The TTE group had longer ICU-free days to day 28 (0.0 vs. 19.0 days, p = 0.010). In our study, trauma team approach had a survival benefit for traumatic high-grade liver injury patients with 65% reduction of risk of death within 72 h (Odds ratio (OR) = 0.35, 95% CI = 0.14–0.86) and 55% reduction of risk of in-hospital mortality (OR = 0.45, 95% CI = 0.23–0.87). A team-based approach might contribute to the survival benefit in patients with traumatic high-grade liver laceration by facilitating patient transfer from outside the hospital, through the diagnostic examination, and to the definitive hemostatic procedures.