Page 25 - World Journal of Laparoscopic Surgery

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

Fig. 30: Average timing for grafting of harvested LIMA to LAD in TECABG Fig. 31: Surgeon’s discomfort level for grafting harvested LIMA to LAD
in TECABG

Fig. 33: Surgeon’s discomfort level for suturing and tying surgeon’s knot
in esophagectomy at 30°, 60°, and 90° port position angles
is to the 90° and above, the more likely it is to take longer operative
time. It might be due to fatigue from increased elevation angle and
overstretching of the shoulder (Figs 34 and 35).
From above figures and discussion, it is obvious that the
Fig. 32: Average timing in seconds for suturing and tying surgeon’s knot surgeon’s discomfort level is least at the 60° port position.
in esophagectomy at 30°, 60°, and 90° port position angles
dIscussIon
are 1.09, 0.29, and 0.48. The lowest time required is at 60° angle
manipulation (Figs 32 and 33). A total of 30 procedures were done in this prospective experimental
The average timings in seconds for 30°, 60°, and 90° were animal study. The TTP of port placement was used. Three thoracic
340.33, 304.50, and 359.33, respectively. The first two readings were and two cardiac procedures were included. The details of the
reproducible at a p value of 30.141) at 5% level of significance. It was procedures are as follows: lung resection—6 (20% of total case),
found that the 60° angle has shorter operative time than that of 30° thymectomy—6 (20% of total case), closure of ASD—6 (20% of
and 90° angle. It shows increased difficulties and time consumption total case), IMA harvesting for TECABG—6 (20% of total case), and
when ports are placed in such a manner that will give working esophagectomy—6 (20% of total case) on 30 animals through
angles of 90° and above. minimal access techniques.
Execution time (sum of the ports access time and the actual
Timing for Purse String Suture Placement for a Circular Stapler procedure time), error rates, and the surgeon’s discomfort for each
in Esophagectomy of the three angles of manipulation were evaluated.
Average timings (mean time) in seconds for purse string suture Lung Resection
placement for a circular stapler in esophagectomy at 30°, 60°, and
2
90° angle are 635.50, 598.50, and 659.33, respectively. χ values at Timing for Suturing and Tying Surgeon’s Knot in Lung
those angles are 0.34, 0.18, and 0.26. The lowest time required is at Resection
60° angle manipulation. In this study, it was found that average timings (mean time) in
From above discussions, with 60° manipulation angle the seconds for suturing and tying surgeon’s knot in lung resection at
average timings of all tasks were shorter and all were reproducible. 30°, 60°, and 90° angle are 311.83, 304.33, and 344.50, respectively.
2
All the tasks were difficult and time-consuming when they were χ values at those angles are 6.55, 2.73, and 10.84. The lowest time
followed by 30° and 90° angle. The closer the manipulation angle required is at 60° angle manipulation.

World Journal of Laparoscopic Surgery, Volume 12 Issue 3 (September–December 2019) 111