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e, transfusion rate, post-operative complications and OR time compared favorably. Using calculations based on published data, the potential cost savings are in the 1 to 2 million dollar range compared to traditional endoscopic or open procedures reported to the STS. Conclusions High acuity services such as Thoracic Surgery drive higher CM per case as long as variable costs especially LOS are kept low. Procedures with lower CMI may not provide a high enough CM to offset the fixed and variable costs. Capsazepine cost Robotic surgical cases performed in the outpatient setting may incur significant losses as the reimbursement does not cover the direct costs. Hospitals should preferentially allocate robotic resources to inpatient procedures with higher CMI and work to decrease overall LOS. 2020 Journal of Thoracic Disease. All rights reserved.Background Video-assisted thoracoscopic trans-subxiphoid surgery is an ideal technique for removing anterior mediastinal lesions. The diffusion of this method, however, has been limited by the complexity of surgical maneuvers to be performed in the narrow retrosternal space. Robotic surgery holds promise to overcome the technical limitations of the thoracoscopic trans-subxiphoid approach. Here, we describe a case series of patients who had undergone trans-subxiphoid robotic surgery-with a special focus on short-term outcomes. Methods Between January 2018 and January 2019, a total of 20 patients underwent trans-subxiphoid robotic surgery for maximal thymectomy or removal of anterior mediastinal masses. A 3-cm longitudinal incision was performed below the xiphoid process, through which carbon dioxide was insufflated and a camera port was inserted. Subsequently, the lower sections of the mediastinal pleura were detached bilaterally-followed by the creation of two bilateral 1-cm skin incisions on the anterior axillary line in the sixth intercostal space for the insertion of robotic arms. Upon completion of port positioning, the surgical robot was docked. Results All robotic surgery procedures were successfully completed. Neither conversion to open surgery nor the creation of additional ports was required. The median operating time and console time were 118 min [interquartile range (IQR) 84-147 min] and 92.5 min (IQR 78.5-133.5 min), respectively. Drainage tube positioning was not required in 11 (55%) patients. There were no operative deaths, and the median length of postoperative hospital stay was 2.5 days (IQR 2-3 days). One patient had postoperative chylothorax and received conservative treatment. Conclusions The results of this case series provide initial support to the clinical feasibility, safety, and short-term positive outcomes of trans-subxiphoid robot-assisted surgery for anterior mediastinal disease. 2020 Journal of Thoracic Disease. All rights reserved.Minimally invasive thoracoscopic surgical techniques have grown increasingly popular due to improved outcome measures compared to conventional rib-spreading thoracotomy. However, video-assisted thoracoscopic surgery (VATS) presents with unique technical challenges that have limited its role in certain cases. Here, we discuss our perspectives on the implementation of a successful robotic thoracic program. We will then present the case for how the adoption of robotic assisted thoracic surgery (RATS) provides the benefits of minimally invasive VATS while still retaining the technical finesse of bimanual articulating instruments and 3-dimensional imaging that is a universal component of any open surgery. We will also discuss how to overcome some of the perceived disadvantages to RATS in regard to the higher cost, lack of tactile feedback and potential safety concerns. 2020 Journal of Thoracic Disease. All rights reserved.Robotic thymectomy is widely accepted as a valuable treatment option for surgical resection of thymic epithelial tumor as minimally invasive surgery has shown better early clinical outcomes than open surgery. Technical advances in robotic surgery have expanded the indications for robotic thymectomy, and the technique can be used to perform complete resection of advanced thymic epithelial tumor requiring concomitant resection of adjacent structures. To ensure complete resection, a multi-disciplinary approach, with thorough preoperative evaluation, must be adopted to determine whether a patient shows surgical indications for advanced thymic epithelial tumor. The early clinical outcomes after robotic thymectomy to treat advanced thymic epithelial tumor are promising; however, the long-term oncologic outcomes should be evaluated in the further studies. 2020 Journal of Thoracic Disease. All rights reserved.Esophagectomy for cancer of the esophagus is increasingly performed using minimally invasive techniques. After the introduction of minimally invasive esophagectomy (MIE) in the early 1990's, robotic-assisted techniques followed after the turn of the millennium. The advent of robotic platforms has allowed the development of robotic-assisted minimally invasive esophagectomy (RAMIE) over the past 15 years. Although recent trials have shown superior peri-operative morbidity and quality of life compared to open esophagectomy, no randomized trials have compared RAMIE to conventional MIE. This paper summarizes the current literature on RAMIE and provides an overview of expected future developments in robotic surgery. 2020 Journal of Thoracic Disease. All rights reserved.High dose melphalan is commonly used as a conditioning regimen for autologous stem cell transplantation in multiple myeloma. There are reports of adverse cardiac events with melphalan manifested by supraventricular tachycardia and atrial fibrillation. Here, we report a rare case of a 58 year old female with multiple myeloma, who developed sinus arrest after autologous stem cell transplantation using high dose melphalan as a conditioning regimen. It was severe and rare, therefore, monitoring for cardiac toxicity in patients receiving high-dose melphalan is mandatory. © The Author(s). 2020.Humans have the ability to report the contents of their subjective experience-we can say to each other, 'I am aware of X'. The decision processes that support these reports about mental contents remain poorly understood. In this article, I propose a computational framework that characterizes awareness reports as metacognitive decisions (inference) about a generative model of perceptual content. This account is motivated from the perspective of how flexible hierarchical state spaces are built during learning and decision-making. Internal states supporting awareness reports, unlike those covarying with perceptual contents, are simple and abstract, varying along a 1D continuum from absent to present. A critical feature of this architecture is that it is both higher-order and asymmetric a vast number of perceptual states is nested under 'present', but a much smaller number of possible states nested under 'absent'. Via simulations, I show that this asymmetry provides a natural account of observations of 'global ignition' in brain imaging studies of awareness reports.