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Non-robotic thoracoscopic internal mammary artery preparation in the pig. A training model

^a Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
^b Institute for Clinical Experimental Surgery, University of Saarland, Homburg/Saar, Germany

*Corresponding author. Tel.: +41 91 805 3144; fax: +41 91 805 3148.

E-mail address: demertzis{at}cardiocentro.org (S.D. Demertzis).

Notwithstanding non-robotic, thoracoscopic preparation of the internal mammary artery (IMA) is a difficult surgical task, an appropriate experimental training model is lacking. We evaluated the young domestic pig for this purpose. Four domestic female pigs (30–40 kg body weight) were used for this study. Bilateral thoracoscopic preparation of the IMA was carried out under continuous, pressure controlled CO₂ insufflation. A 30° rigid thoracoscope was inserted through a 10-mm port in the 5th/6th intercostal space (ICS) dorsally to the posterior axillary line. The dissection instrument (Ultracision Harmonic Scalpel) was inserted (5-mm port) in the 7th ICS at the posterior axillary line and the endo-forceps (5-mm port) in the 5th ICS at the posterior axillary line. Thoracoscopic IMA preparation in pig resulted more difficult than in man. A total of seven IMAs were prepared in their full intrathoracic length. A change in the preparation technique (lateral detachment of the endothoracic muscle) improved the safety of the procedure, allowing all four respective IMAs to be prepared safely, while the initial technique ensued an injury for 2 out of 3 vessels. The described young domestic pig model is suitable for experimental training of bilateral thoracoscopic IMA preparation.

Key Words: Thoracoscopy; Animal model; Endoscopy/endoscopic procedures; Experimental surgery; CABG arterial grafts