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WJOLS

Comparing Task Performance and Comfort during Nonpulmo nary Video-assisted Thoracic Surgery

three ports to make an equilateral triangle between the
optical port, the 1st working instrument and the target. A 3rd
port (usually used for introduction of grasping forceps) is
placed close to the target and hence called the target port
(Figs 2A and B).
Most of the procedures done using the TTP when it was
introduced involved lung resections and there is a need to
assess the use of the TTP in nonpulmonary procedures and
compare it with the conventional BDP.

MATERIALS AND METHODS

Thirty-six nonpulmonary VATS procedures were conducted
on swine models by the candidate at the Institute of Minimal
Access Surgery, the Global, Open, University in the World
laparoscopy Hospital, Gurgaon, India, over 6 months
between 19/09/2013 and 23/03/2014. Twelve pigs were used and
three procedures were done on each animal. The procedures
include 12 pericardial window, 12 esophagocardiomyotomy
and 12 thoracic sympathectomy. Six of each of the proce-
dures were done using BDP and six using TTP.
Fig. 1: Baseball diamond concept The outcome measures are execution time (seconds),
of the catcher at the home plate, the 1st working instrument errors (pericardial window-myocardial injury; esophago-
at the 1st baseman location, the target at the 2nd baseman cardiomyotomy-esophageal perforation, aortic injury and
position and the 2nd working instrument corresponds to the thoracic sympathectomy-intercostal vessels bleeding) and
position of the 3rd baseman. Thus, the optical port is placed surgeons discomfort level as analyzed by visual analog
directly opposite the target and the working instruments are system (VAS) ranging from 1 to 10 in increasing discomfort
lateral to the optical port. pattern.
The experience that BDP may pose difficulties in some The research was an animal study which is strictly
VATS procedures led to the introduction of an alternative regulated in India under the provisions of section 15 of the
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principle to ensure better task performance. Sasaki et al Prevention of cruelty to Animals Act, 1960, and the rules
pointed to the difficulty they experienced in treating thoracic under the Act of 1998 and 2001. This is enforced by the
lesions especially peripheral lung lesions using the BDP and committee for the Purpose of control and Supervision of
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they developed and introduced the triangle target principle experiments on Animals (cPcSeA). In conducting this
(TTP) to solve the difficulty. They also concluded that research the operational guidelines for observance of good
the application of TTP for ports placement can be used to practices by the cPcSeA was strictly adhered to. Permission

access and treat all thoracic lesions. The TPP involves placing and approval for procurement of the pigs from cPcSeA

A B
Figs 2A and B: Geometry for (A) baseball diamond and (B) triangle target principles
World Journal of Laparoscopic Surgery, May-August 2014;7(2):60-65 61