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

Abstract

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

Simulation‐based surgical education in cardiothoracic training

“…Fasotec, in Japan, created 3D printed models consisting of a human skeleton model simulating a rib cage and internal organs. When the Biotexture TM lung is installed in this simulated thoracic cavity, can be adapted to different levels of difficulty and be used effectively in surgical training (27,28). These simulators, although realistic, need to be fully assessed before incorporating them as a tool for official training programmes.…”

International Learner Perceptions, Educational Value, and Cost Associated With the Use of Start-to-Finish Surgical Simulation Compared With Cadaveric Models

“…11,23,24 Polymer hydrogels have been previously investigated in simulating human soft tissue for use in surgical simulation, although the existing models are disadvantaged by complex synthesis requirements and inability to replicate a simulation experience that is completely compatible with electrocautery and detailed anatomic structures. [25][26][27][28] This emphasizes one of the novel advantages of our simulator design: the purposeful insertion of tendinous attachments of posterior musculature in anatomically correct positions for exposure of the cervical and lumbar spine. This differs from alternative methods of soft tissue simulation with thermoplastic polymers that simply "fill" the empty space around 3D printed structures.…”

Design and preliminary validation of a high-fidelity vascular simulator for robot-assisted manipulation

“…PVA is a water-based cross-linked polymer whose mechanical properties can be tuned by using a freeze‒thaw process to closely match those of human soft tissues 31 . In addition, PVA is electroconductive, thus enabling the use of electrocautery or other energy device 32 for vessel isolation tasks, as is commonly done during surgery. For the soft surrounding tissue, we chose (4 g of PVA in 100 ml of distilled water) PVA because it better replicates the mechanical properties of human tissue (according to indications noted in the literature) 31 .…”