# Update Course 2021: THORACOTOMY VS VATS FOR OSTEO METS — GCMD Library

<p>The management of lung metastases in osteosarcoma may necessitate deciding approach–either thoracotomy or VATS. At the 2021 Pediatric Surgery Update Course, Dr. Anusua "Roshni" Dasgupta, MD reviewed the latest literature.</p>


Type: video · posted 2022-05-24
Canonical: https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417

## Chapters
- [0:00](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=0) Introduction and ICG for Cholecystectomy
- [3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214) ICG Cholecystectomy Technique and Timing
- [9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574) ICG for Partial Nephrectomy and Varicocele Repair
- [21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284) Pulmonary Metastasectomy Case Discussion

## Statements
- "In adult centers, surgeons perform 100 to 300 cholecystectomies per year compared to 10 to 30 per year in pediatric centers" — Chiro Esposito (epidemiological) [3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)
- "ICG is a soluble molecule that rapidly binds to albumin and is removed from circulation by the liver into bile juice" — Chiro Esposito (clinical) [0:23](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=23)
- "For cholecystectomy, ICG must be injected 12 to 15 hours preoperatively to allow secretion into bile juice for selective biliary tree visualization" — Chiro Esposito (clinical) [7:15](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=435)
- "If ICG is injected intraoperatively for cholecystectomy, the liver takes up the dye and appears green, making gallbladder identification difficult" — Chiro Esposito (clinical) [7:51](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- "For all ICG indications except cholecystectomy (kidney, varicocele, lymphoma, tumors), the injection is given intraoperatively" — Chiro Esposito (clinical) [7:51](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=471)
- "ICG vial contains 25 mg in 4 ml, diluted with 10 ml sterile water, with 6 ml injected intravenously for cholecystectomy" — Chiro Esposito (clinical) [4:40](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=280)
- "For partial nephrectomy in duplex kidney, ICG is injected three times: via ureteral catheter to identify normal ureter, intravenously to visualize kidney vasculature, and intravenously again after vessel clipping to show devascularization line" — Chiro Esposito (clinical) [9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- "In duplex kidney with reflux, the two ureters are attached to each other, making identification of the normal ureter difficult without ICG" — Chiro Esposito (clinical) [9:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=574)
- "For varicocele repair, intratesticular injection of 2 ml ICG solution allows intraoperative fluorescence lymphography to identify and spare lymphatic vessels" — Chiro Esposito (clinical) [17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "Palomo varicocele repair has success rate of more than 97-98% but ligating lymphatics in the spermatic bundle causes postoperative hydrocele in about 20% of cases" — Chiro Esposito (clinical) [17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "In a series of more than 150 varicocele patients using ICG lymphatic sparing technique, there were zero postoperative hydroceles" — Chiro Esposito (clinical) [19:10](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1150)
- "The spermatic bundle contains three to four lymphatic vessels" — Chiro Esposito (clinical) [17:30](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1050)
- "There is no maximum dose limit for ICG based on adult surgery studies" — Chiro Esposito (clinical) [21:53](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1313)
- "ICG vial remains usable for six hours after preparation" — Chiro Esposito (clinical) [21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- "No adverse effects of ICG were observed in the presenter's experience" — Chiro Esposito (clinical) [21:24](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=1284)
- "ICG technology can be used in both laparoscopy (requiring special camera and optic) and robotic surgery with Da Vinci XI Firefly system" — Chiro Esposito (clinical) [1:20](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=80)
- "The newer Rubin ICG system allows visualization in color with biliary tree appearing green, compared to older systems showing black and white images" — Chiro Esposito (clinical) [5:40](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=340)
- "For elective cholecystectomy cases, patients are hospitalized the day before surgery for ICG injection in the late afternoon if surgery is scheduled early morning" — Chiro Esposito (clinical) [8:42](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=522)
- "ICG technology helps reduce complications in laparoscopic cholecystectomy, particularly beneficial for trainees and in centers with longer learning curves due to lower case volumes" — Chiro Esposito (opinion) [3:34](https://library.globalcastmd.com/watch/update-course-2021-thoracotomy-vs-vats-for-osteo-mets-5417?t=214)

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Not medical advice · citation policy: https://library.globalcastmd.com/ai