Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
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200 papers
[Intersegmental Dissection Using Microwave Energy].
Nagashima T, Ohtaki Y
Kyobu Geka · 2025 Sep · PMID 40998356
Lung segmentectomy for small peripheral lung cancers has been increasingly performed in recent years. A critical step in this procedure is the intersegmental plane dissection, which, if not performed properly, may lead t...
Lung segmentectomy for small peripheral lung cancers has been increasingly performed in recent years. A critical step in this procedure is the intersegmental plane dissection, which, if not performed properly, may lead to complications such as prolonged air leakage. Traditionally, electrocautery and staplers have been commonly used for this purpose. In this report, we describe our experience using a domestically developed microwave surgical instrument. This device utilizes 2,450 MHz microwave energy to vibrate water molecules within tissue, creating a uniform coagulation layer while keeping tissue temperatures below 100 ℃. This allows for effective sealing of the lung parenchyma. Additionally, its scissor-like shape enables intuitive and precise handling during dissection. Our initial experience demonstrated minimal intraoperative bleeding and a low rate of postoperative complications. These results suggest that the microwave surgical device may offer a safe and effective alternative for lung parenchymal dissection in segmentectomy. Its ability to create a consistent seal without excessive thermal damage may help improve surgical outcomes and reduce postoperative morbidity. This technique could be particularly useful in cases requiring precise anatomical dissection, supporting its broader adoption in thoracic surgery.
[Ablation Treatment for Peripheral Lung Cancers].
Yamauchi Y, Sakao Y
Kyobu Geka · 2025 Sep · PMID 40998355
Ablation therapy is a minimally invasive local treatment that destroys tumor tissue. It has attracted attention as a treatment option for early-stage lung cancer and metastatic lung tumors. In this review, we provide an...
Ablation therapy is a minimally invasive local treatment that destroys tumor tissue. It has attracted attention as a treatment option for early-stage lung cancer and metastatic lung tumors. In this review, we provide an overview of the current status of treatment, technical characteristics, indications, and treatment results for three ablation methods for peripheral lung lesions: radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (PCT). RFA is relatively simple to perform, but its therapeutic effect is limited in tumors near blood vessels due to the influence of heat diffusion by blood vessels and bronchi. MWA enables wide-range ablation in a short time compared to RFA and has the advantage of being less affected by blood vessels and bronchi. PCT enables easy confirmation of the ablation range because it can be visualized as an ice ball on computed tomography (CT) fluoroscopy and is less painful for the patient. It is characterized by the induction of tumor cell death by apoptosis and the preservation of tissue structure. The indications for ablation therapy are mainly early-stage non-small cell lung cancer (NSCLC) that is difficult to surgically resect. Patients with high surgical risk, such as elderly patients and patients with serious complications, are targeted. The combination of ablation therapy and immunotherapy is expected to have a therapeutic effect, and systemic antitumor effects through the release of tumor-associated antigens can be expected. In the future, further expansion of treatment options for lung cancer is expected with the development of optimal combination methods with immunotherapy and the development of transbronchial approaches.
[Photodynamic Therapy for Peripheral Lung Cancer].
Usuda J
Kyobu Geka · 2025 Sep · PMID 40998354
Photodynamic therapy (PDT) utilizes a tumor-specific photosensitizer with low-power laser irradiation and this treatment has been established for centrally located lung cancers. However, its application to peripheral typ...
Photodynamic therapy (PDT) utilizes a tumor-specific photosensitizer with low-power laser irradiation and this treatment has been established for centrally located lung cancers. However, its application to peripheral type lung cancers remains investigational. Recently, there has been interest in minimally invasive ablative therapies are needed for peripheral type lung cancer and several bronchoscopic ablative modalities are currently under investigation. In this study, a novel laser probe was developed and a multicenter randomized clinical trial was conducted to assess the safety and efficacy of PDT for peripheral lung cancer, and to establish a novel bronchoscopic treatment. Patients with non-small cell lung cancer diagnosed by transbronchial lung biopsy with a tumor diameter of 25 mm or less and ineligible for surgery or radiotherapy were enrolled. A randomized controlled trial was conducted with a 2:1 ratio between the PDT group and the best supportive care (BSC) group. The primary endpoint was progression-free survival (PFS), and the secondary endpoint was overall survival (OS). For the BSC group, salvage PDT (sPDT) was permitted for patients with a PD diagnosis and a tumor diameter of 30 mm or less. Patients were enrolled from May 2020 to May 2023 at six hospitals, with a total of 54 cases included, including 35 cases in the PDT group and 19 cases in the BSC group. Among the cases in the BSC group, sPDT was performed in 14 cases. The median PFS was 12.7 months [95% confidence interval (CI): 6.7, 30.0] in the PDT group, and the median PFS was 4.1 months (95% CI: 2.9, 7.4) in the BSC group. Kaplan-Meier survival analysis (log-rank test, p=0.0172) demonstrated a significant prolongation of the PFS in the PDT group. The incidence of serious adverse events was 5.9% (two patients) in the PDT group and 0% in the sPDT group. The findings of this study indicate that PDT for peripheral lung cancer led to a significantly prolongation of PFS and was safe to perform. PDT demonstrated efficacy in preserving lung function, inhibiting lung cancer progression, and maintaining a good quality of life.
[Robotic Bronchoscopy:Current Status and Future Perspectives].
Nakajima T
Kyobu Geka · 2025 Sep · PMID 40998353
Robotic bronchoscopy is an innovative bronchoscopic technique that combines advanced navigation systems with precise robotic control. This integration allows for highly accurate maneuvering and enhanced procedural safety...
Robotic bronchoscopy is an innovative bronchoscopic technique that combines advanced navigation systems with precise robotic control. This integration allows for highly accurate maneuvering and enhanced procedural safety, thereby contributing to further minimally invasive approaches in bronchoscopic diagnostics. In addition to diagnostic applications, its superior reach and stability suggest promising potential for future therapeutic interventions, such as bronchoscopic ablation. These developments indicate that a "one-stop shop" encompassing both diagnosis and treatment of lung cancer may soon become a reality. Although robotic bronchoscopy has not yet been introduced in Japan, its adoption is rapidly progressing in North America. Furthermore, other regions are also witnessing increased regulatory approvals and implementation of robotic-assisted bronchoscopic systems. As technological advancements continue and clinical evidence accumulates, the global dissemination of robotic bronchoscopy is expected to accelerate, potentially transforming the landscape of pulmonary medicine.
[Lung Resection by Using da Vinci SP].
Kaneda S, Kawaguchi K
Kyobu Geka · 2025 Sep · PMID 40998352
In this paper, we would like to discuss the usefulness and safety of lung resection by using the da Vinci SP. Thirty-seven patients who underwent surgery for lung cancer from February to December 2024 at our hospital wer...
In this paper, we would like to discuss the usefulness and safety of lung resection by using the da Vinci SP. Thirty-seven patients who underwent surgery for lung cancer from February to December 2024 at our hospital were included. The mean age was 70 (28~87) years, 21 were male and 16 were female, with a median operative time of 213 (135~417) minutes and a median console time of 149 (96~254) minutes. The resected lungs were the right upper lobe in 11 cases, the right middle lobe in 3 cases, the right lower lobe in 9 cases, the left upper lobe in 5 cases and the left lower lobe in 10 cases. The conversion to thoracotomy was performed in 2 cases. Postoperative complications included atrial fibrillation, decreased intestinal peristalsis due to vagal neuropathy, and pneumonia, but no complications above Clavien-Dindo classification grade Ⅲ were observed. Although there are very small number of reports, those have shown that thoracic surgery using the da Vinci SP has been performed safely. Lung cancer surgery with the da Vinci SP is still in its infancy, and further expansion of the device and cost reductions are desirable.
[Robotic Mediastinal Tumor Surgery Using da Vinci Single-port( SP) Surgical System].
Hoshikawa Y, Ishizawa H
Kyobu Geka · 2025 Sep · PMID 40998351
The da Vinci single-port (SP) surgical system is a new system in which a camera and three robotic forceps are inserted into the body through a single small wound for surgical manipulation. This paper outlines the basic t...
The da Vinci single-port (SP) surgical system is a new system in which a camera and three robotic forceps are inserted into the body through a single small wound for surgical manipulation. This paper outlines the basic techniques and tips for mediastinal tumor surgery using the da Vinci SP, especially the subxiphoid single-port approach. In addition, we will discuss the subcostal approach single-port middle or posterior mediastinal tumor surgery. The subxiphoid approach with the da Vinci SP requires specific tips and precautions, such as avoiding interference between the camera and forceps, forceps and another forceps, forceps and wound margin, and arm and pubic bone or lower extremity, but it is possible to perform thymectomy with good operability and minimal risk. Thymectomy using the da Vinci SP allows for unilateral pleural preservation and surgery that is almost equivalent to an extended thymectomy. Similarly, middle and posterior mediastinal tumor surgery via the subcostal approach with this system requires specific tips and precautions to avoid chylothorax and diaphragmatic hernia, as well as pain management measures such as modified-thoraco-abdominal nerves through perichondrial approach (m-TAPA) block.
[Uniportal Robotic Assisted Pulmonary Resection].
Ose N, Shigetsu K
Kyobu Geka · 2025 Sep · PMID 40998350
BACKGROUND: We introduced the uniportal robotic assisted thoracic surgery (URATS) using da Vinci Xi in 2023 after notification to and approval by the Highly Difficult and New Medical Technology Review Division of the Osa...
BACKGROUND: We introduced the uniportal robotic assisted thoracic surgery (URATS) using da Vinci Xi in 2023 after notification to and approval by the Highly Difficult and New Medical Technology Review Division of the Osaka University Hospital. In our department, URATS is indicated for c-stage 1 lung cancer, metastatic lung tumors, and benign diseases. METHODS: The cross-shaped center guide point is aligned with the dorsal surface of the window. The most dorsal arm is not used, and the camera is placed on the dorsal side. The assistant checks which arm is interfering and adjusts the position and height of the port to find a point where there is no interference. It is also important to select a field of view that allows safe manipulation of the target structure without interference, rather than sticking to one field of view. DISCUSSION: One of the advantages of the URATS is that it allows for a close view. While this allows for highly accurate surgery, it also has disadvantages in terms of cost and learning curve. We plan to continue to accumulate and validate cases, as this may be a beneficial treatment option for patients.
[Implantable Left Ventricular Assist Device].
Mutsuga M
Kyobu Geka · 2025 Sep · PMID 40998349
Drug-resistant severe heart failure significantly impairs cardiac pump function, affecting both prognosis and quality of life (QOL). When conventional treatments are ineffective, a ventricular assist device (VAD) can sup...
Drug-resistant severe heart failure significantly impairs cardiac pump function, affecting both prognosis and quality of life (QOL). When conventional treatments are ineffective, a ventricular assist device (VAD) can support heart function. Heart transplantation remains the ultimate treatment, but donor shortages and eligibility constraints limit access. The left ventricular assist device (LVAD) is a crucial option, serving as a bridge to transplantation (BTT) or a permanent destination therapy (DT) for ineligible patients. In Japan, DT was covered by insurance in 2021, expanding from 7 to 19 facilities by 2023. Key differences between BTT and DT include the removal of the age limit (65 years) and reduced caregiver requirements. LVAD technology has advanced, with miniaturization improving implantation feasibility and reducing surgical burden. Pump designs have evolved from pulsatile to continuous-flow types, with axial and centrifugal models enhancing efficiency. Innovations in biocompatibility and wireless power transmission aim to reduce complications and improve long-term outcomes. BiVACOR, a fully implantable total artificial heart using magnetic levitation, was first clinically tested in 2024. While currently limited to temporary use before transplantation, further advancements may lead to broader applications, enhancing patient survival and QOL.
[Microaxial Flow Pump( Impella):Clinical Evidence and Guideline].
Toda K
Kyobu Geka · 2025 Sep · PMID 40998348
The Impella is a catheter-based microaxial flow pump that is inserted through a small vascular graft (Impella 5.5) or directly from femoral artery (Impella CP) and placed across the aortic valve. By draining blood from t...
The Impella is a catheter-based microaxial flow pump that is inserted through a small vascular graft (Impella 5.5) or directly from femoral artery (Impella CP) and placed across the aortic valve. By draining blood from the left ventricle and pumping it to the ascending aorta, the device not only increases cardiac output, but also unloads the left ventricle which facilitates recovery of damaged cardiac muscles. It has been used in more than 14,000 cardiogenic shock patients in Japan and excellent clinical outcomes have been published in more than 20 major journals in the last three years using J-PVAD registry which is a mandatory national database. New evidences and guidelines may upgrade the value of this device as a less invasive left ventricular unloading device even more in the near future.
[Evolution and Future Prospects of Transcatheter Aortic Valve Implantation].
Sonoda H, Shiose A
Kyobu Geka · 2025 Sep · PMID 40998347
With the aging population, the prevalence of aortic stenosis (AS) is increasing, and transcatheter aortic valve implantation (TAVI) has become a promising treatment, particularly for high-risk patients. Over the past dec...
With the aging population, the prevalence of aortic stenosis (AS) is increasing, and transcatheter aortic valve implantation (TAVI) has become a promising treatment, particularly for high-risk patients. Over the past decade, TAVI technology has advanced rapidly, and three major devices-SAPIEN (balloon-expandable), Evolut (self-expanding), and Navitor (self-expanding)-are now widely used in Japan. Each device offers unique structural and procedural characteristics: SAPIEN provides precise positioning and strong anti-paravalvular leak features; Evolut offers excellent hemodynamics, especially in small annuli; and Navitor features a flexible delivery system and enhanced sealing via NaviSeal. Long-term data show favorable outcomes for all devices, though each has distinct advantages and limitations. Recent concerns include the management of younger patients and the rise in TAVI explant procedures. Thus, selecting the optimal device based on patient anatomy, risk profile, and future reintervention potential is increasingly emphasized. This review summarizes the key features and clinical outcomes of these devices and discusses future directions toward personalized treatment strategies, including lifetime management approaches. As TAVI expands to lower-risk and younger populations, balancing durability, procedural safety, and reintervention strategies will be essential to ensuring long-term clinical success.
[Endovascular Repair].
Inoue Y, Matsuda H
Kyobu Geka · 2025 Sep · PMID 40998346
Thoracic endovascular aortic repair (TEVAR) has made a significant contribution to the treatment of aortic dissection. Comprehensive management of aortic surgery, including lifesaving and prevention of aortic complicatio...
Thoracic endovascular aortic repair (TEVAR) has made a significant contribution to the treatment of aortic dissection. Comprehensive management of aortic surgery, including lifesaving and prevention of aortic complications, is more important than ever in Japan, where the population is aging, through the successful use of TEVAR in combination with conservative treatment and open repair. The evolution of new technologies, such as bifurcated stent grafts, is expected to lead to more advanced treatment.
[Prosthetic Heart Valves:Recent Advances and Future Perspectives].
Fujimori T, Yamaguchi A
Kyobu Geka · 2025 Sep · PMID 40998345
Recent years have witnessed significant advancements in prosthetic heart valves, particularly bioprosthetic valves. The main challenges for bioprosthetic valves have been structural valve deterioration (SVD) and long-ter...
Recent years have witnessed significant advancements in prosthetic heart valves, particularly bioprosthetic valves. The main challenges for bioprosthetic valves have been structural valve deterioration (SVD) and long-term durability. This review focuses on three major innovations: anti-calcification treatments, valve-in-valve (ViV) compatible designs, and sutureless/rapid deployment valves. Modern bioprosthetic valves incorporate proprietary anti-calcification technologies that have demonstrated excellent mid-term durability in clinical trials. Valve designs increasingly consider future ViV procedures, incorporating features such as expandable bands, optimized dimensions, and enhanced radiopaque markers. Sutureless/rapid deployment valves have shown promising results with reduced operative times, particularly beneficial for minimally invasive approaches. Recent guidelines reflect these advances, with age thresholds for bioprosthetic valves decreasing. Emerging evidence suggests tissue-specific characteristics may influence valve selection. Future developments will likely focus on further enhancing durability and establishing personalized valve selection algorithms.
[Surgical Ablation Devices].
Ishii Y
Kyobu Geka · 2025 Sep · PMID 40998344
In arrhythmia surgery, creating a reliable conduction block is fundamental. Traditional cut-and-sew techniques, while effective, pose risks such as bleeding and prolonged operative time. Modern surgical ablation devices-...
In arrhythmia surgery, creating a reliable conduction block is fundamental. Traditional cut-and-sew techniques, while effective, pose risks such as bleeding and prolonged operative time. Modern surgical ablation devices-such as cryoablation, radiofrequency, microwave, and ultrasound-enable targeted, transmural myocardial necrosis with greater safety and efficiency. However, improper use or incomplete ablation may lead to residual conduction, resulting in arrhythmia recurrence or new arrhythmogenic circuits. Each device has distinct energy sources, thermal profiles, and tissue interactions. Cryoablation, for example, remains reliable with minimal collateral damage, while bipolar radiofrequency allows precise, real-time monitoring of lesion transmurality. Ultrasound and microwave technologies offer deeper tissue penetration but have varying long-term efficacy. Thorough understanding of device characteristics, lesion depth, and intraoperative confirmation of conduction block is essential. As minimally invasive techniques advance, the role of appropriately selected and applied ablation devices becomes increasingly vital for safe and effective arrhythmia surgery.
[Recent Advances in Surgical Instrumentation for Minimally Invasive Cardiac Surgery].
Sakaguchi T
Kyobu Geka · 2025 Sep · PMID 40998343
Minimally invasive cardiac surgery (MICS) has revolutionized the field of cardiac surgery by offering reduced surgical trauma, shorter hospital stays, and faster patient recovery compared to conventional median sternotom...
Minimally invasive cardiac surgery (MICS) has revolutionized the field of cardiac surgery by offering reduced surgical trauma, shorter hospital stays, and faster patient recovery compared to conventional median sternotomy. The success of MICS heavily depends on the continuous advancements in surgical instrumentation. This review discusses the recent innovations in surgical tools and technologies designed to enhance precision, safety, and efficiency in MICS. Key developments include robotic-assisted systems, endoscopic instruments, percutaneous devices, and novel visualization techniques. We further explore the clinical impact of these technologies and future prospects in the field.
[Surgical Skills Training Device].
Tamaki R, Abe K
Kyobu Geka · 2025 Sep · PMID 40998342
Currently, board certification for cardiovascular surgeons in Japan mandates a minimum of 30 hours of off the job training (OJT). However, starting in June 2024, training hours will be doubled when conducted under the au...
Currently, board certification for cardiovascular surgeons in Japan mandates a minimum of 30 hours of off the job training (OJT). However, starting in June 2024, training hours will be doubled when conducted under the auspices of the Japanese Societies of Thoracic, Cardiovascular, and Vascular Surgery, and increased by 1.5 times when using animal tissue, simulators, or three dimensional (3D) printing models. The growing adoption of minimally invasive techniques has led to a decline in traditional median sternotomy procedures, thereby reducing direct operative experience for young surgeons and underscoring the need for innovative training methods. Simulation tools in cardiovascular surgery span a wide range in both fidelity-the extent to which a model replicates real anatomical conditions-and cost. Options vary from low-cost, low-fidelity homemade models using everyday materials to high-fidelity systems employing porcine hearts or cadaveric tissues. Recent innovations include smartphone-based applications, such as the e-Suture app, which provides objective evaluations of needle handling, and online training platforms that have enabled remote coronary artery anastomosis training during the coronavirus disease (COVID)-19 pandemic. Moreover, high-fidelity simulators using 3D printing technology and robotic surgery training devices have broadened the scope of available educational resources. Ultimately, it is most important for trainees to be aware of the need to transfer their skills to clinical practice when undergoing training.
[The Management Methods for Cardiopulmonary Bypass and Control Features in the Modern Heartlung Machines].
Kashiwa K
Kyobu Geka · 2025 Sep · PMID 40998341
While it may seem that there have been no significant changes in the field of cardiopulmonary bypass (CPB) over the past decade, there have been advances in management concepts, such as coagulation management strategies...
While it may seem that there have been no significant changes in the field of cardiopulmonary bypass (CPB) over the past decade, there have been advances in management concepts, such as coagulation management strategies and the use of oxygen delivery index (DO2i) and carbon dioxide (CO2)-derived variables during CPB. It will be important to examine what changes in outcomes are observed as a result of advances in management methods. The development of a variety of monitoring devices is expected if better outcomes are observed as a result of advances in CPB management. In addition, the introduction and study of different perfusion-assist functions are hoped to lead to the automation of operations in CPB.
[Intraoperative Monitoring of Cerebral and Spinal Cord Perfusion in Thoracic and Thoracoabdominal Aortic Surgery].
Henmi S, Okada K
Kyobu Geka · 2025 Sep · PMID 40998340
Neurological complications during thoracic and thoracoabdominal aortic surgery remain significant issues affecting both postoperative quality of life and long-term survival. Inadequate cerebral and spinal cord perfusion,...
Neurological complications during thoracic and thoracoabdominal aortic surgery remain significant issues affecting both postoperative quality of life and long-term survival. Inadequate cerebral and spinal cord perfusion, as well as embolic events, are major contributors to such outcomes. Near-infrared spectroscopy (NIRS)-based regional cerebral oxygen saturation (rSO2) monitoring allows continuous, non-invasive assessment of cerebral perfusion and has become a routine adjunct in high-risk procedures. Factors such as mean arterial pressure, arterial carbon dioxide tension (PaCO2), hemoglobin levels, and cardiac output all significantly influence rSO2 values. For spinal cord protection, motor evoked potential (MEP) monitoring provides a real-time assessment of the corticospinal tract integrity. Its utility is particularly prominent in thoracoabdominal aortic aneurysm repairs where spinal ischemia poses a risk of paraplegia. Prompt intraoperative responses-such as increasing blood pressure, cerebrospinal fluid drainage, or intercostal artery reconstruction-can be initiated based on MEP changes. At our institution, over 300 cases have been managed with MEP guidance, yielding favorable neurological outcomes. Integration of NIRS and MEP enables early detection of ischemia and timely interventions, thereby reducing neurological complications. Continued refinement and standardization of these modalities, in conjunction with other physiological and imaging assessments, are essential to further improve surgical outcomes.
[Intraoperative Transesophageal Echocardiography].
Orihashi K
Kyobu Geka · 2025 Sep · PMID 40998339
Transesophageal echocardiography (TEE) is a valuable diagnostic and intraoperative tool that allows high-resolution, real-time imaging of deep cardiovascular structures without interfering with surgery. It offers dynamic...
Transesophageal echocardiography (TEE) is a valuable diagnostic and intraoperative tool that allows high-resolution, real-time imaging of deep cardiovascular structures without interfering with surgery. It offers dynamic information similar to computed tomography (CT) or magnetic resonance imaging (MRI) but without radiation exposure, making repeated assessments feasible. During cardiovascular surgery, TEE guides cannula placement, monitors myocardial protection, detects complications like air embolism and intraoperative aortic dissection, and facilitates real-time surgical navigation. Its utility extends to postoperative intensive care unit (ICU) care and emergency settings, where it helps diagnose complications when CT is not feasible. In thoracic surgery, TEE aids in assessing tumor invasion into cardiovascular structures. However, TEE's effectiveness heavily relies on the operator's skill, unlike the objectivity of radiologic modalities. Thus, fostering collaboration between anesthesiologists and surgeons is essential. As a critical part of perioperative management, TEE proficiency is now a requirement for board certification in cardiovascular anesthesia in Japan. Supporting anesthesiologists in developing TEE skills enhances surgical outcomes and institutional capability.
[Energy Devices and Soft Coagulation].
Homma T, Saji H
Kyobu Geka · 2025 Sep · PMID 40998338
The increasing variety of energy devices and modes in thoracic surgery, driven by evolving surgical approaches, presented challenges in selection and understanding. This paper addressed this by reviewing the principles,...
The increasing variety of energy devices and modes in thoracic surgery, driven by evolving surgical approaches, presented challenges in selection and understanding. This paper addressed this by reviewing the principles, characteristics, adverse events, and effective application of radiofrequency, ultrasonic, and microwave devices, including recent innovations and soft coagulation. The goal was to guide clinicians towards informed decision-making in their choice of energy modalities.
[Current Status and Future Prospects of Covering, Reinforcement, and Sealant Materials in Thoracic Surgery].
Ichimura H, Yanagihara T
Kyobu Geka · 2025 Sep · PMID 40998337
Various types of covering materials, reinforcement materials, and sealants with different compositions and structures are available in the field of thoracic surgery. However, complications such as infection, adhesion, an...
Various types of covering materials, reinforcement materials, and sealants with different compositions and structures are available in the field of thoracic surgery. However, complications such as infection, adhesion, and deformation of the materials, as well as hematoma caused by bleeding, chylothorax from lymphatic leakage, and pneumothorax or empyema due to air leaks, still occur at a certain rate. These issues indicate that the functions of currently available materials do not yet fully meet the needs of thoracic surgeons. In this article, we provide an overview of the classification, characteristics, and limitations of materials currently approved for use in Japan. Furthermore, we introduce recent advances in the development of novel materials-particularly surgical sealants-including an Alaska pollock gelatin sealant that we are co-developing for clinical application. In the development of new materials, improvements in physical properties, along with the availability of different formulations-such as liquid and sheet types-are expected to broaden their clinical applicability. The properties and limitations of each material are closely interrelated, and a thorough understanding of both is essential for optimal material selection and appropriate clinical use.
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