Page 28 - World Journal of Laparoscopic Surgery

Evaluation of Various Port Positions for Minimal Access Cardiovascular and Thoracic Procedures
They mentioned that the increased error rates and surgeon’s There should be caution when translating this data to humans
discomfort can be explained by the mirror image produced when as the swines have some peculiarities such as flimsy tissues and
using TTP and the flimsy nature of the swine tissue giving rise to shortened thoracic space. Surgical simulation using animal models
injury to the esophagus and the encircling structures even with may be the high fidelity method and should be encouraged
minimal force. whenever feasible. Sheep can be an alternative to the swine as
The prolongation of the execution time when BDP was used they have stronger tissues.
which is in contrast to the trends of the error rates and the surgeon’s
discomfort might have been due to the increased error rates in TTP Limitations
use. When these major errors are encountered, the procedure does The sample size is small. It may affect the extrapolation of the
not typically proceed and the execution time when using TTP is results. This is because the study on animal models is guided by
recorded as shortened. This calls for more data from larger sample stringent legislations and requirements, which limit the sources.
size to revalidate this and provide more explanations. The swine are smaller and adult VATS instruments were used.
The observed BDP seems to be better than the TTP of ports So, some ergonomic difficulties are obvious. The appropriate
placement for VATS esophagocardiomyotomy in terms of the error location of the intercostal spaces and ports placement were more
rates and the surgeon’s discomfort, although it took longer time challenging. Translation of the data to humans may also be affected
to be executed. by some differences with the swine as the space between the
They concluded that the TTP might have clear benefit over BDP anterior and posterior ALs and the intercostal spaces are narrower
when treating different esophageal diseases requiring stapling such than those in human. There could be other confounding variables
as esophageal diverticulum or during esophagectomy because of such as dysfunctional instruments that could have impacted on
the 90° manipulation angle between the grasping forceps and the the measures of outcome.
stapler. It clearly supports the present study.
Yunusa et al. and Ismail performed study on VATS thoracic references
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114 World Journal of Laparoscopic Surgery, Volume 12 Issue 3 (September–December 2019)