M.T. Gómez-Hernández

Teaching video-assisted thoracic surgery lobectomy—using an ex vivo simulation model

Video-assisted thoracic surgery (VATS) is gradually replacing conventional open thoracotomy as the standard approach of many lung resections and thoracic surgical trainees and experienced surgeons must learn and master this technique. Simulation based training may be a good option to acquire or improve these advanced skills, however realistic and inexpensive simulators are not accessible or commercially available. We developed a low cost and hi fidelity simulation model using porcine heart-lung blocks.

Effective instruction by novel simulation technique

Background: Less than 38% of lobectomies are performed videothoracoscopically in Europe. A training tool can help to develop video-assisted thoracoscopic surgery (VATS) programs. Methods: A heart-and-lung tissue block from swine is employed as ex vivo VATS training tool by 5 surgeons. Surgeons were divided in three expertise groups. Thirty swine lobectomies were completed, and evaluated in swine lobectomy number 1, 10, 20 and 30. Results: The improving percentage between pre-project and post-project evaluation was 0% (beginner group), 54.3% (intermediate group) and 31.7% (expert group). We prove that the model is of relevant help to surgeons already performing VATS lobectomies with not a high expertise level. Conclusions: An ex vivo simulation program can help to establish and consolidate a VATS program in a safety way with low morbidity and conversion rates.

Refraining from smoking shortly before lobectomy has no influence on the risk of pulmonary complications: a case-control study on a matched population†

Objectives Whether or not smoking increases the risk of postoperative pulmonary complications (PPCs) in lung resection patients remains controversial. The objective of this study was to evaluate whether active smoking at the time of surgery increases the risk of PPCs compared to abstention shortly before the procedure. Methods We conducted a case-control study on 378 patients who underwent non-extended lobectomy in our institution. Cases were active smokers at the time of surgery, and controls were patients who quit smoking at any time up to 16 weeks before surgery. All patients received the same perioperative care, including chest physiotherapy. The occurrence of PPCs was the considered outcome. PPCs were defined as pneumonia (American Thoracic Society criteria, 2004) or atelectasis requiring bronchoscopy. Cases and controls were matched according to age, body mass index, forced expiratory volume in the first second of expiration (FEV1%), FEV1/forced vital capacity, type of approach and diagnosis of non-small-cell lung cancer. We calculated the odds ratio (OR) with 95% confidence interval (CI) for PPCs. Results The overall prevalence of PPCs was 4.7% (18/378); 5.3% (13 out of 244) in the active smokers group and 3.7% (5 out of 134) in the ex-smokers group. After matching, two sets of 134 patients each were compared. The prevalence was 4.5% (6/134) in active and 3.7% (5/134) in ex-smokers (OR 1.21 95% CI: 0.29-5.13, P  =   0.76). Conclusions In this population of patients strictly matched according to risk criteria for PPCs, smoking at the time of surgery was not identified as a risk variable. Therefore, the practice of postponing surgery until tobacco abstention has been achieved does not seem to be justified.