Non-robotic thoracoscopic internal mammary artery preparation in the pig. A training model
Stefanos D. Demertzis 1*,
Matthias W. Laschke 2,
Francesco P.A. Siclari 1,
Michael D. Menger 2
1 Cardiocentro Ticino, Lugano, Switzerland
2 University of Saarland, Homburg/Saar, Germany
* To whom correspondence should be addressed. E-mail: stefanos{at}demertzis.net.
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Abstract |
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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 7 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 4 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. Keywords: Thoracoscopy; Animal model; Endoscopy/endoscopic procedures; Experimental surgery; CABG arterial grafts.
