Background: Uniportal video-thoracoscopic lobectomy has improved postoperative outcomes in lung cancer patients. Thus, thoracic surgeons are increasingly required to learn this new approach. Methods: We evaluate the path of a single surgeon switching from triportal video-thoracoscopic lobectomy to the uniportal, using the cumulative sum (CUSUM) analysis, in a single center to assess the learning curve, enrolling 107 uniportal video-thoracoscopic lobectomies consecutively performed. CUSUM analysis detected how many uniportal video-thoracoscopies occur to obtain changes in mean operation time, among all procedures consecutively performed. CUSUM analysis identified the cut-off at the 67th procedure; this value was used to divide all patients into two groups: group A (first 67 patients, early phase) and group B (40 patients, experienced phase). Then, we analyze the perioperative outcomes between the two groups. Results: Gender characteristics of the two groups were statistically similar. Median operative time decreased significantly after the early phase [188 min (IQR: 151–236) vs. 170.5 (IQR: 134–202) (p-value = 0.02)], respectively. Similarly, during the second phase, the conversions rate decreased: [10 (15%) (group A) vs. 1 (2%) (group B) (p-value = 0.04)], as did the postoperative complications [28 cases (42%) vs. 9 cases (22%) (p-value = 0.04)] and the length of stay [6 days (IQR 5–9.5) vs. 5 days (IQR 4–8) (p-value = 0.04)], giving evidence of skills acquired in the second phase. Conclusions: CUSUM analysis identified 67 uniportal lobectomies, after which operative time, conversion rate, and perioperative complications significantly decreased; the moving average analysis further supports a progressive reduction in operative time. Despite prior multiportal video-thoracoscopic experience, switching to uniportal video-thoracoscopy requires a distinct learning process.

Background: Mediastinal paragangliomas (MPs) are rare, highly vascular neuroendocrine tumors whose surgical resection is the gold standard but carries a high risk of perioperative complications due to the MPs’ proximity to major cardiovascular structures with potential life-threatening hemorrhage. Due to their rarity, the literature consists primarily of case reports. Our systematic review aims to synthesize the evidence from the last two decades to propose a standardized, multidisciplinary approach to the diagnosis and surgical management of MPs. Methods: A systematic literature review was conducted from 2005 to 2025. Studies reporting on surgically resected adult mediastinal paragangliomas were included. Patient demographic data, diagnostic workup, surgical approaches, and outcomes were extracted and analyzed descriptively. Results: Analysis of 79 patients from 75 papers revealed a median age of 50 years (female predominance of 62%). Most tumors were in the middle mediastinum (51.9%). Sternotomy was the most common surgical approach (44.3%), with cardiopulmonary bypass utilized in 27.8% of cases. Postoperative complications occurred in 28% of patients, with left vocal cord palsy (12.7%) being most frequent. The median follow-up was 12 months. All percentages refer to the number of patients. Conclusions: Surgical removal is the standard of care for curative treatment of MPs. However, surgical treatment requires meticulous planning within a multidisciplinary team to reduce the risk of perioperative complications. The choice of surgical approach—open, minimally invasive, or with circulatory support—depends on tumor site, size, and vascular involvement. This review consolidates existing evidence of MPs’ surgical management, aiming to mitigate the significant risks associated with surgery. Lifelong follow-up is essential due to the potential for recurrence.

Microscopic thymoma (MT) is defined as solitary or multifocal small thymic epithelial nests <1 mm in diameter, occurring in approximately 15% of patients with myasthenia gravis (MG) and sometimes associated with thymic cysts. Its preoperative diagnosis is challenging due to its small size, and computed tomography (CT) scans are unable to detect it. MTs are considered incipient or precursor lesions of thymoma, detectable only via microscopic examination. We report a case of MT identified pathologically in the thymic tissue surrounding a thymic cyst in a 52‐year‐old female hospitalized for drooping eyelids and muscle weakness. A mediastinal CT scan revealed an enlarged thymic gland with an associated cyst in the anterior mediastinum. Due to symptomatic disease, we performed a right video‐assisted thoracoscopic thymectomy. No macroscopic tumor was observed, but histopathological analysis revealed an acquired multilocular thymic cyst with multiple thymic epithelial islands (MTs) in the surrounding thymic tissue. All previous cases reported, except one, were symptomatic for MG and none were diagnosed before surgery. The morphological pattern of MT differs from conventional thymoma, and the latest WHO classification categorizes it as thymic nodular hyperplasia. To maximize the detection of MT nests, complete resection and thorough histopathological examination of the thymic gland and surrounding tissue are essential, even in the absence of macroscopic lesions. Here, we propose key points for the evaluation and management of MT.

Background/Objectives: Despite the widespread adoption of minimally invasive video-assisted thoracoscopic surgery (VATS) for pulmonary lobectomy and Enhanced Recovery After Surgery (ERAS) protocols, routine chest X-rays (CXRs) in the Post-Anesthesia Care Unit (PACU) after VATS pulmonary lobectomy remain common. Evidence questioning their clinical utility in asymptomatic patients is growing. This study aimed to evaluate the therapeutic yield of routine PACU CXRs following VATS lobectomy, in a homogeneous cohort (PACU time point). Methods: This single-center retrospective cohort study included 554 consecutive patients who underwent elective VATS lobectomy (2014–2025). The primary endpoint was the therapeutic yield of routine PACU CXRs, defined as the proportion directly leading to a documented change in postoperative management. Secondary outcomes included the yield of post-drain-removal CXRs, radiographic findings, and the yield in patients with intraoperative complications. Results: Among 554 routine PACU CXRs, only 12 (2.2%; 95% CI: 1.1–3.7) led to a management change; surgical re-intervention was required in 1 patient and chest tube reinsertion in 5 patients. By contrast, 93 post-drain-removal CXRs (16.8%; 95% CI: 13.7–20.0) led to a change (p < 0.001). The most frequent abnormal findings were pneumothorax (5.8%), atelectasis (4.5%), and pleural effusion (2.0%). Routine PACU imaging generated an estimated cost of €16.620 and a cumulative radiation exposure of 27.7 mSv. Conclusions: Routine PACU CXR after VATS lobectomy has a very low therapeutic yield and rarely changes management in asymptomatic patients. These findings support a selective, symptom-driven imaging strategy, although further prospective studies are needed to confirm safety and effectiveness.