New Trainer for Video-Assisted Thoracic Surgery Lobectomy

Iwasaki, Atsushi; Moriyama, Shigeharu; Shirakusa, T

doi:10.1055/s-2007-965739

Cited by 15 publications

(14 citation statements)

References 14 publications

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“…To address these concerns, Iwasaki and colleagues developed a VATS training method using a dry box with an anatomically correct model in the early stages of VATS procedures (2). They designed a lung model consisting of lung parenchyma, pulmonary arteries, veins, and bronchi made with foamed polyurethane.…”

Section: Discussionmentioning

confidence: 99%

“…In Japan, board certification by the Japanese Association for Chest Surgery requires participation in a VATS training course consisting of basic dry box training and wet-lab training using an anesthetized porcine model. In order to support the learning of this comparatively difficult technique, various training methods and simulators have been developed, including cadaveric training, the use of extracted porcine or bovine cardiopulmonary tissue blocks, and virtual reality simulators (1)(2)(3). In this report, we introduce VATS training for lobectomy using a three-dimensional modeled rib cage accommodating a non-biological lung model that provides an anatomical structure and texture close to that of a human.…”

Section: Introductionmentioning

confidence: 99%

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Video-assisted thoracoscopic surgery training with a polyvinyl-alcohol hydrogel model mimicking real tissue

Satô

Morikawa

2017

J. Vis. Surg.

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Video-assisted thoracoscopic surgery (VATS) has become increasingly accepted, and the thoracic surgeon must be proficient in this technique. Although the advantages of VATS are widely acknowledged, the procedures are technically challenging and may result in catastrophic complications. Thus, the importance of VATS training has long been recognized and various training simulators are available. In this report, we introduce a training method using a new simulator comprising polyvinyl-alcohol (PVA) hydrogel mimicking real human anatomy and texture.Keywords: Video-assisted thoracoscopic surgery (VATS); minimally invasive thoracic surgery; simulator; training Training of VATS segmentectomyTraining session records of left upper lobe lobectomy (superior segmentectomy) are shown in Figures 5,6. During the procedures, the trainee was able to see through to the inside of the chest cavity to check and understand the optimized direction of the instruments or staplers. In Figure 6, the trainee and the instructor interrupted the procedure and pulled out the model from the rib cage to examine the three-dimensional structure of the vessels and the bronchus. Note that this model provided lung parenchyma that can be resected by electrocautery and energy devices, and also presented an accurate three-dimensional structure that included the division of vessels and bronchi allowing for realistic segmentectomy training. DiscussionThe advantages of VATS over thoracotomy (including reduced perioperative complications and shorter length of stay with equivalent oncologic outcomes) have been recognized for years. Accordingly, the number of VATS lobectomy procedures has doubled in the past decade; approximately 36% of lobectomies in Japan were performed using VATS in 2005, and recent statistics have shown that the figure doubled in 2015 (10,11). Thus, VATS procedures have become a de facto necessary skill for thoracic surgeons to learn.In pulmonary resections, comprehensive understanding of the anatomical structures of pulmonary arteries, veins, and bronchi is essential. These networks intersect each other in a complicated manner, and incomplete fissure may further obscure these structural relationships. In the thoracoscopic setting, the placement, scope, and movement of the instruments are limited because of the patient's hard bony rib cage, which restricts the field of view and perspective. Therefore, training with a simulator that provides a bony rib cage is ideal for addressing these issues.Training systems that use living animals have numerous advantages. Pulsation and the movement of the mediastinum driven by respiration provide realistic sensations. Trainees can also gain experience in tissue incision, dissection, coagulation hemostasis using electrocautery, energy devices, ultrasound devices, as well as actual procedures. In addition, they can learn how to prevent and manage injuries to the vessels and lung parenchyma. The major drawback

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic surgery training with a polyvinyl-alcohol hydrogel model mimicking real tissue

Satô

Morikawa

2017

J. Vis. Surg.

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“…Our results showed clearly that surgical tasks such as tying, suturing, and dissecting were as accurate and as fast as maneuvers performed in the initial phases of this training program. The trainer served to enhance the training of surgeons while concurrently diminishing the use of experimental models and surgical mistakes [11,14].…”

Section: Discussionmentioning

confidence: 99%

“…Surgeons who want to introduce minimally invasive technologies into their clinical area need to develop special skills using animal laboratories or training models [11][12][13] that closely resemble the human conditions [14].…”

Section: Discussionmentioning

confidence: 99%