title: Video-assisted thoracoscopic surgery in swine: an animal model for thoracoscopic lobectomy training.
abstract: OBJECTIVE
  Minimally invasive thoracic procedures have been increasingly used; however, only a small number of lobectomies are performed by videothoracoscopy, showing the need for training on this technique. The objective of this study is to demonstrate the technique of lobectomy using videothoracoscopy in swine, highlighting the steps to be taken during its use in surgical experimentation.
  
  
  METHODS
  During the advanced course on video-assisted and thoracoscopic procedures carried out at IRCAD Latin America, Barretos, Brazil, 40 swine were used for the hands-on course on video-assisted upper left lobectomy. Monopulmonary ventilation was performed by blocking the left main bronchus. Surgical procedures were performed using three ports and the anterior dissection technique (fissureless approach). The pulmonary hilar structures were dissected using conventional open surgery and video-assisted surgical tools. The first structure treated in the approach of the hilar structures was the upper lobe vein, followed by the bronchus and the branches of the pulmonary artery.
  
  
  RESULTS
  The mean time required to anaesthetize the animals was 3 h. Intraoperative hypoventilation was observed in 26 animals (65%) and 4 (10%) of them had a poor outcome and died in the last third part of the surgery. Eight (20%) animals had bradycardia, and six responded to the use of atropine. In two (5%), it was not possible to revert the bradycardia and the animals died at the end of the procedures. The surgical procedures had a mean duration of 3 h and the total time of anaesthesia was about 6 h.
  
  
  CONCLUSIONS
  Swine have been frequently used for hands-on training in surgery but there are no reports in the literature describing the anatomical, anaesthetic and technical peculiarities that must be observed during videothoracoscopic lobectomy training in swine. Video-assisted thoracoscopic surgery lobectomy using swine is an adequate method to train thoracic surgeons. For surgeons to make the best use of minimally invasive technique training, it is essential that issues related to the anatomy, anaesthesia, monopulmonary ventilation and surgical technique described in this study are taken into account.
authors.affiliation: American Institute of Telesurgery (AMITS), Barretos, SP, Brazil tedde@usp.br.
authors.forename: Miguel L
authors.initials: ML
authors.lastname: Tedde
authors.affiliation: Brazilian Society of Thoracic Surgery, Sociedade Brasileira de Cirurgia Torácica, SBCT, São Paulo, SP, Brazil.
authors.forename: Flavio
authors.initials: F
authors.lastname: Brito Filho
authors.affiliation: American Institute of Telesurgery (AMITS), Barretos, SP, Brazil.
authors.forename: Emilio de Almeida
authors.initials: Ede A
authors.lastname: Belmonte
authors.affiliation: Department of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Darcy Ribeiro
authors.initials: DR
authors.lastname: Pinto Filho
authors.affiliation: American Institute of Telesurgery (AMITS), Barretos, SP, Brazil.
authors.forename: Sergio Tadeu Fortunato Lima
authors.initials: ST
authors.lastname: Pereira
authors.affiliation: American Institute of Telesurgery (AMITS), Barretos, SP, Brazil.
authors.forename: Erica Mie
authors.initials: EM
authors.lastname: Okumura
authors.affiliation: American Institute of Telesurgery (AMITS), Barretos, SP, Brazil.
authors.forename: Armando G Franchini
authors.initials: AG
authors.lastname: Melani
authors.affiliation: Thoracic Department, Institut Mutualiste Montsouris, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Gossot
mesh_terms: D000818:Animals; D023421:Models, Animal; D011013:Pneumonectomy / Q000193:education* / Q000379:methods; D013552:Swine; D020775:Thoracic Surgery, Video-Assisted / Q000193:education* / Q000379:methods
keywords: Animal; Minimally invasive surgery; Swine; Thoracic surgery; Thoracoscopic surgery; Training; Video-assisted; models