Video-assisted thoracoscopic surgery in swine: an animal model for thoracoscopic lobectomy training

Tedde, Miguel Lia; Filho, Flávio Brito; Belmonte, Emílio de Almeida; Filho, Darcy Ribeiro Pinto; Pereira, Sergio Tadeu Fortunato Lima; Okumura, Erica Mie; Melani, Armando Geraldo Franchini; Gossot, Dominique

doi:10.1093/icvts/ivv138

Cited by 23 publications

(12 citation statements)

References 14 publications

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“…Tedde et al wrote in 2015 an interesting paper about their experience in swine wet lab for left VATS upper lobectomy (19). In this study, 40 swine were employed in a wet lab teaching video-assisted left upper lobectomy.…”

Section: Wet Labmentioning

confidence: 98%

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The role of wet lab in thoracic surgery

et al. 2017

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During the last three decades, minimally invasive surgery has become common practice in all kinds of surgical disciplines and, in Thoracic Surgery, the minimally invasive approach is recommended as the treatment of choice for early-stage non-small cell lung cancer. Nevertheless, all over the world a large number of lobectomies is still performed by conventional open thoracotomy and not as video-assisted thoracic surgery (VATS), which shows the need of a proper training for this technique. Development and improvement of surgical skills are not only challenging and time-consuming components of the training curriculum for resident or fellow surgeons, but also for more experienced consultants learning new techniques. The rapid evolution of medical technologies like VATS or robotic surgery requires an evolution of the existing educational models to improve cognitive and procedural skills before reaching the operating room in order to increase patient safety. Nowadays, in the Thoracic Surgery field, there is a wide range of simulation-based training methods for surgeons starting or wanting to improve their learning curve in VATS. Aim is to overcome the learning curve required to successfully master this new technique in a brief time. In general, the basic difference between the various learning techniques is the distinction between "dry" and "wet" lab modules, which mainly reflects the use of synthetic or animal-model-based materials. Wet lab trainings can be further sub-divided into in vivo modules, where living anaesthetized animals are used, and ex vivo modules, where only animal tissues serve as basis of the simulation-based training method. In the literature, the role of wet lab in Thoracic Surgery is still debated. In general, the basic difference between the various learning techniques is the distinction between "dry" and "wet" lab modules, which mainly reflects the use of synthetic or animal-model-based materials (9,10). Wet lab trainings can be further sub-divided into in vivo modules, where living anaesthetized animals are used, and ex vivo modules, where only animal tissues serve as basis of the simulation-based training method. In the literature, the role of wet lab in Thoracic Surgery is still debated. Dry labThe advances in the experience with minimally invasive techniques and the introduction of new instrumentation that needed to be tested in a non-clinical environment and eventually discussed or improved by technicians or bio-medical engineers have led to the evolution of dry laboratories. These working environments are providing simulators such as box trainers and virtual reality (VR) simulators (11). But where laparoscopic surgery has undergone a rapid evolution of the simulation-based training methods for the training and assessment of technical skills in general surgical procedures, the parallel development of models for minimally invasive thoracic surgical procedures has not arisen in the same manner. The reasons behind this are probably multifactorial. Thoracic procedures are less stand...

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Section: Wet Labmentioning

confidence: 98%

“…In fact, pigs have four pulmonary lobes on the right side and two on the left side. Generally, the lower lobes are bigger than the upper lobes (19). Surgical procedures like VATS lobectomies can be carried out on both sides.…”

Section: Wet Labmentioning

confidence: 99%

The role of wet lab in thoracic surgery

et al. 2017

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“…76,77 Utilization of animal models and video simulations were implemented for training, but there has not yet been an established formal curriculum, especially in the training of general surgeons who may practice in the community. [77][78][79][80][81][82] As an alternative to centralization of lung cancer surgery and minimally invasive techniques, a formalized training curriculum for these surgeons may help close the disparity in the adoption of thoracoscopic surgery.…”

Section: Training Utilization and Adoption Of Vats Lobectomymentioning

confidence: 99%

VATS and Minimally Invasive Resection in Early-Stage NSCLC

Salfity

Tong

2020

Semin Respir Crit Care Med

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Lung carcinoma widely affects men and women in the sixth and seventh decades of life. Thorough workup with radiographic imaging, pathologic diagnosis, and cardiopulmonary functional assessment is key to successful treatment. Accurate staging is essential for both assessing prognosis and directing therapy. Early-stage lung cancer is most often treated with anatomic lobectomy; locally advanced cancers may require induction or adjuvant therapies. Any nonnodal metastases will require definitive systemic therapy. Traditionally, surgery was performed with a posterolateral thoracotomy incision, division of the hilar vessels, removal of affected lung parenchyma, and a complete mediastinal and hilar lymph node dissection for accurate pathologic staging. In recent years, however, video-assisted thoracoscopic (VATS) or other minimally invasive approaches have emerged as the standard of care for early-stage disease. Compared with standard thoracotomy, VATS lobectomy offers improved postoperative outcomes as well as potential survival benefit. Thoracoscopic lobectomy is also cost-effective. This article focuses on the technique, outcomes, adaptation, and evolution of thoracoscopic lobectomy and other minimally invasive techniques in the treatment of lung cancer.

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“…The swine is a validated model in thoracic surgery training and it has been used both in a live (11) and ex vivo model (12). There are no reports in the English literature about a perfused ex vivo model.…”

Section: Universidad Catolica De Chile Uniportal Videoassisted Thoracmentioning

confidence: 99%

Uniportal video-assisted thoracic surgery lobectomy using a novel perfused ex vivo simulation model

et al. 2016

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Simulation may provide a solution to acquire advanced skills in thoracic surgery, however to date there are no reports in the English literature about a perfused ex vivo model. We developed a low cost and hi fidelity model using an ex vivo in bloc heart and lung specimen from a swine. The swine was previously used in a non-thoracic experiment, so we extracted the lung and heart for this ex vivo based model to reduce animal use. The cost of the whole model is 70 USD and it can be reused many times changing the ex vivo tissue, so this model may help reduce the costs and animal use associated to this high complexity surgery. Model and video descriptionAs in a traditional uniportal human surgery, the model has a 4 cm utility incision. A 30° 10 mm camera was used in the posterior aspect of the incision. First, the left superior lobe is retracted posteriorly for hilum exposure. The anterior structure is the superior pulmonary vein. After opening the mediastinal pleura, dissection of the superior pulmonary vein is performed with blunt dissection and with an energy device. Section of the vein is made with a vascular endostapler. This exposes the main pulmonary artery. The next step is to identify the arterial branches for the superior lobe and divide them with a vascular stapler. To finalize, the upper lobe bronchus is dissected and then cut with a medium thickness endo-stapler.In the video, the setting of the surgeon and his assistant is shown in a comparable fashion to a human uniportal vats surgery (Figures 4,5).By pulmonary artery cannulation, the lung can be perfused with simulated blood allowing a more accurate vascular dissection.In order to demonstrate how well the system is perfused, a continuous bleeding secondary to an intentional arterial cut was shown. As this is a simulated blood perfused model it allows the operator to dissect the vessels in a more realistic setting (the vessels are not collapsed) and to see bleeding in case of any damage. ConclusionsA low cost and hi fidelity perfused uniportal VATS model was validated by an expert thoracic surgeon in uniportal VATS. This model may help reduce the costs and animal use associated to this high complexity surgery.

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Video-assisted thoracoscopic surgery in swine: an animal model for thoracoscopic lobectomy training

Cited by 23 publications

References 14 publications

The role of wet lab in thoracic surgery

The role of wet lab in thoracic surgery

VATS and Minimally Invasive Resection in Early-Stage NSCLC

Uniportal video-assisted thoracic surgery lobectomy using a novel perfused ex vivo simulation model

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