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WJOLS

Ahmad Jameel Ismail, RK Mishra 10.5005/jp-journals-10033-1218
OriginaL articLe

Comparing Task Performance and Comfort during

Nonpulmo nary Video-assisted Thoracic Surgery
Procedures between the Application of the ‘Baseball

Diamond’ and the ‘Triangle Target’ Principles of

Port Placement in Swine Models

1 Ahmad Jameel Ismail, RK Mishra
2

ABSTRACT Keywords: Video-assisted thoracic surgery, Ports placement,
Baseball diamond, Triangle target.
Objective: The baseball diamond principle (BDP) is the con-
ventional principle used for ports placement in video-assisted How to cite this article: Ismail AJ, mishra RK. Comparing Task
thoracic surgery (VATS). The triangle target principle (TTP) was Performance and Comfort during Nonpulmo nary Video-assisted
introduced as an alternative principle where BDP is associated Thoracic Surgery Procedures between the Application of the
with difficulties especially in lung resections. We compared ‘Baseball Diamond’ and the ‘Triangle Target’ Principles of Port
the task performance and surgeon’s discomfort during some Placement in Swine models. World J Lap Surg 2014;7(2):60-65.
nonpulmonary VATS procedures between using the BDP and Source of support: Nil
TTP in swine models.
Conflict of interest: None
Materials and methods: Thirty-six nonpulmonary VATS pro-
cedures were done on swine models at the World Laparoscopy
Hospital, Gurgaon, NCR Delhi, India, from 19th February 2013 INTRODUCTION
to 23rd march 2014. The procedures are 12 VATS pericardial
window, 12 esophagocardiomyotomy and 12 thoracic sympa- Video-assisted thoracic surgery (VATS) or thoracoscopic
thectomy (6 using BDP and 6 using TTP of each procedure). surgeries refer to totally thoracoscopic approaches, where
The outcome measures were the execution time, the errors rate
and the surgeon’s discomfort. visualization is dependent on video monitors, and rib spre a -
ding is avoided by using a thoracoscope, video monitors and
Results: Video-assisted thoracic surgery pericardial window
1
using TTP took longer time to be executed with a mean diffe- one to four small (1-2 cm) incisions. VATS involve the use
rence of 93 seconds when compared to using BDP but the errors of ports through which long instruments including thora-
rates and surgeon’s discomfort was similar between BDP and
TTP. VATS eso phagocardiomyotomy using BDP took longer time coscope, graspers, scissors, forceps, retractors are passed
with a mean difference of 326.67 seconds but using the TTP into the chest cavity via 1 to 2 cm skin incisions. There
was associated with more errors and surgeon’s discomfort. In are ergonomic principles governing the positioning and
VATS thoracic sympathectomy using the BDP took longer time
with a mean difference of 194 seconds, but the execution time placement of these ports to facilitate task performance and
data using BDP was not reproducible when validated statisti- surgeons comfort. These principles include the following:
cally. The errors rates and surgeon’s discomfort was similar • The optical trocar port is placed at the center so that the
between BDP and TTP.
telescope will come to lie between the working instru-
Conclusion: Using baseball diamond principle appears to ments.
lead to better task performance and less Surgeon’s discomfort
during some nonpulmonary VATS procedures in swine models • The instruments should act as type 1 lever with equal
but there is need for studies with larger sample size. TTP use length inside and outside the peritoneal or thoracic cavity.
may be more favored during nonpulmonary VATS when stapling • The manipulation angle between the two working instru-
will be required.
ments should optimally be 60° (elevation angles of 30°
and azithmus angle of 15-45°).
2
1 Senior Registrar, Director, Professor and Senior Consultant • The working instruments should not face or work against
the telescope as this leads to production of mirror image
1 Department of Surgery, Cardiothoracic Surgery Unit, Aminu
Kano Teaching Hospital, Kano, Nigeria and difficult task execution with increased error rate.
To achieve above principles, the baseball diamond prin-
2 Department of Laparoscopic Surgery, World Laparoscopy
Hospital, Gurgaon, Haryana, India cipal (BDP) is used in deciding the sites of ports placement.
The BDP is the conventional principle used in laparoscopic
Corresponding Author: Ahmad Jameel Ismail, Senior
2-5
Registrar, Department of Surgery, Cardiothoracic Surgery Unit and VATS. In BDP, the position of the baseball infielders
Aminu Kano Teaching Hospital, PmB 3452, Kano, Nigeria (infield players) is used as the position of the ports (Fig. 1).
e-mail: iajameel@yahoo.com
The optical port for the telescope is placed at the position
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