Slipping rib syndrome (SRS) is a disorder that occurs when one or more of the eighth through tenth ribs become abnormally mobile. SRS is a poorly understood condition leading to a significant delay in diagnosis and therapeutic management. History and a physical exam are usually sufficient for a diagnosis of SRS. The utility of dynamic ultrasounds has also been studied as a useful diagnostic tool. Multiple surgical techniques for SRS have been described within the literature. Cartilage rib excision (CRE) has been the most common technique utilized. However, the literature has shown a high rate of recurrence and associated risks with the procedure. More recently, minimally invasive rib fixation and costal cartilage excision with vertical rib plating have been shown as successful and safe alternative techniques. This may be an effective, alternative approach to CRE in adult and pediatric populations with SRS.

Thoracic outlet syndrome (TOS) involves the compression of neurovascular structures in the thoracic outlet. TOS subtypes, including neurogenic (nTOS), venous (vTOS), and arterial (aTOS) are characterized by distinct clinical presentations and diagnostic considerations. This review explores the incidence, diagnostic challenges, and management of TOS with a focus on the innovative approach of Robotic First Rib Resection (R-FRR). Traditional management of TOS includes conservative measures and surgical interventions, with various open surgical approaches carrying risks of complications. R-FRR, a minimally invasive technique, offers advantages such as improved exposure, reduced injury risk to neurovascular structures, and shorter hospital stays. A comprehensive literature review was conducted to assess the outcomes of R-FRR for TOS. Data from 12 selected studies involving 397 patients with nTOS, vTOS, and aTOS were reviewed. The results indicate that R-FRR is associated with favorable intraoperative outcomes including minimal blood loss and low conversion rates to traditional approaches. Postoperatively, patients experienced decreased pain, improved function, and low complication rates. These findings support R-FRR as a safe and effective option for medically refractory TOS.

Medicaid expansion (ME) has undoubtedly had noticeable effects on access to cancer screening and treatment across several solid organ malignancies. For patients with breast, colon, and lung cancer, findings show that ME is associated with increased cancer screening, earlier detection, lower disease-related mortality, and overall improved access to care. 1,2 Access to care is paramount in hepatocellular carcinoma (HCC), the mainstay of treatment is surgical management. Hepatocellular carcinoma represents about 70% to 90% of all primary hepatic malignancies, and patients with HCC face an overall poor prognosis unless the disease is found at early stages when surgical management is possible. 3 Evidence suggests that timely receipt of treatment for HCC improves survival, but the effect of increasing access to care via Medicaid expansion on HCC has not been well established. 4,5 This is the question that Henrique et al. 6 sought to address with their study entitled "The Impact of Medicaid Expansion in Early-Stage Hepatocellular Carcinoma Care." This retrospective study collected data from the National Cancer Database (NCDB) and identified 19,745 early HCC patients from 2004 to 2017 by American Joint Committee on Cancer (AJCC) staging. Additionally, patients from states that participated in ME were identified, and outcomes from surgical procedures including ablation, resection, and transplantation in HCC were evaluated. 6,7 The study identified 61% of the patient population as living in a pre-expansion state, with no differences in surgical

Evaluate differences in operative cost in pulmonary resection between patients who had preoperative biopsy via robotic navigational bronchoscopy versus an intraoperative diagnostic wedge. We performed a retrospective cohort study of patients who underwent standard lobectomy at our institution between January 2024 and July 2025. We identified patients who had a preoperative robotic navigational bronchoscopy (Nav) prior to lung resection and those who had no preoperative biopsy (NPB) and had intraoperative diagnostic wedge. We then examined operative time, stapler load quantity, stapler cost, robotic cost, and overall operative cost. 128 patients were identified, 53 in the NPB cohort and 75 in the Nav cohort. The mean age of the cohort was 68. The average surgical cost of the non-preoperative biopsy (NPB) cohort was $10,258.68 and $9,249.36 in the Nav cohort ( P = 0.007). The average stapler loads used, total stapler cost, total robotic I&A costs, and surgical supply costs were higher in the NPB cohort ( P < 0.001). The average technical cost of performing a frozen specimen was $65.35. There was no statistically significant difference in operative time between cohorts, however the NPB cohort had a longer operative time on average (187.83 min vs. 174.63 min, P = 0.161). We found that on average, surgical cost, operative time, robotic cost, and OR charges were higher in patients who had undergone intraoperative frozen section (NPB) compared to those with preoperative biopsy (Nav). This data suggest that the use of preoperative robotic bronchoscopy is associated with decreased cost of robotic lung resection.