Page 21 - World Journal of Laparoscopic Surgery

Evaluation of Various Port Positions for Minimal Access Cardiovascular and Thoracic Procedures

Fig. 13: O-10 and O-5 mm port position and completed task Fig. 14: Preparing gastric conduit

level as analyzed by the visual analogue system (VAS) starting from
110 in increasing the discomfort pattern. These outcome measures
recorded for each procedure were entered into a proforma.
The procedures were done after the swine were given general
anesthesia. The ports were made using a surgical scalpel and CO
2
insufflation was done to collapse the ipsilateral lung. The camera
port was inserted blindly and operating ports were introduced
under direct vision. Video-assisted thoracoscopic surgery ASD
closure either direct closure or pericardial or PTFE patch using
grasper, scissors, retractor, arterial and venous cannula, hook
dissector, cardiopulmonary bypass circuit and Heart-Lung machine.
The VATS esophagectomy was performed with alternating use of
grasper, scissors, and hook dissector. Diathermy and harmonic
device were used to perform thymectomy.
Methods of Data Collection and Analysis
The data were recorded in a preconstructed data collection sheet,
Fig. 15: Cervical incision for anastomosis cleaned and entered into a computer using SPSS version 16 for
Windows. The analysis was done using statistical methods such as
2
probability = 0.991, d = 0.05 precision. Thus n = 1.96 × 0.019 × mean and Chi-square. Results are presented in figures.
2
0.991/0.05 = 28.93. Ethical Considerations
Hence, 30 VATS procedures were done as the sample size.
The research was an animal study that strictly regulated in India
Data Collection underneath the provisions of Section 15 of the Prevention of Cruelty
A total of 30 VATS procedures were conducted on swine at the to Animals Act, 1960, and the principle beneath the Act of 1998
institute of minimal access surgery, World Laparoscopy Hospital, and 2001. It was governed by the Committee for the Purpose of
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NCR Delhi, India, over 11 months from January 15, 2018, to Control and Supervision of Experiments on Animals (CPCSEA).
November 15, 2018. For this analysis, the operational guidelines for Observance of
Three thoracic and two cardiac surgeries were included. good Practices by the CPCSEA were strictly followed. Permission
The details of the procedures are: lung resection: 6 (20% of and approval for procurement of the swine and conduct of the
total case), thymectomy: 6 (20% of total case), closure of ASD: 6 research was obtained from CPCSEA-registered animal breeding
(20% of total case), IMA harvesting for TECABG: 6 (20% of total houses. At the end of the experiments, euthanasia was conducted
case), and esophagectomy: 6 (20% of total case) on 30 animals and therefore the animals’ carcasses were properly disposed
through minimal access techniques. Each procedure was done according to the guidelines.
using TTP.
The outcome measures are: the execution time in seconds (port result And observAtIons
access time plus actual procedure time), error rate (lung perforation, A total of 30 procedures were conducted in this study. The TTP
myocardial injury, injury to the great vessels, injury to the phrenic of port placement was applied. Three thoracic and two cardiac
nerve, esophageal perforation, subdiaphragmatic primary trocar procedures were included. The procedures are lung resection,
entry for esophagectomy and intercostal vessels bleeding for port thymectomy, closure of ASD, LIMA harvesting, and esophagectomy.
placement during LIMA harvesting), and the surgeons’ discomfort It is to evaluate the execution time (sum of the ports access time and

World Journal of Laparoscopic Surgery, Volume 12 Issue 3 (September–December 2019) 107