Operative Planning in Thoracic Surgery: A Pilot Study Comparing Imaging Techniques and Three-Dimensional Printing.

BACKGROUND: Careful preoperative planning in thoracic surgery is essential for positive outcomes, especially in video-assisted thoracic surgery (VATS), where palpation and 3-dimensional (3D) imaging is restricted. This study evaluated the ability of different imaging techniques, such as computed tomography (CT) scanning, maximal intensity projection imaging, 3D reconstruction, and 3D printing, to define the anatomy of the hilar structures before anatomical lung resection. METHODS: All patients undergoing elective lung resections by VATS for cancer under a single surgeon were identified over a 3-month period. The surgeon was asked to record the number of pulmonary artery branches supplying the lobe to be resected by using the preoperative CT scans, maximal intensity projection images, and 3D-reconstructed CT images. The lung hilum in 3 patients was printed. These were then compared with the intraoperative findings. RESULTS: The preoperative imaging of 16 patients was analyzed. The lung hilum was printed in a further 3 patients. Although not statistically significant, the 3D prints of the hilum were the most accurate measurement, with a correlation of 0.92. CT, 3D-reconstructed CT, and maximal intensity projection images tended to underrecognize the number of arterial branches and therefore scored between 0.26 and 0.39 in absolute agreement with the number of arteries found at operation. CONCLUSIONS: 3D printing in the planning of thoracic surgery may suggest a benefit over contemporary available imaging modalities, and the use of 3D printing in practicing operations is being established.

The Requirement of Sutures to Close Intercostal Drains Site Wounds in Thoracic Surgery.

BACKGROUND: Chest drains are used routinely in thoracic surgery. Often a pursestring or mattress suture is used to facilitate closure of the defect on removal of the drain. This stitch can cause an unsightly scar, increase drain removal pain, and necessitate that the patient attend a community health care center to have this removed. The objective of this study was to assess whether this stitch is necessary in modern thoracic surgical practice. METHODS: Data from a single surgeon's practice were collected over an 18-month period. During this time, all patients who underwent both emergency and elective thoracic surgery who had at least one postoperative chest drain of 28F or above inserted were included in the study. The surgeon did not routinely use a suture to close the drain site. RESULTS: In all, 312 patients underwent thoracic surgery during the 18-month period. Each patient had a range of 1 to 3 drains inserted of a size between 28F and 32F. No patients had drain sutures for closure of the drain site. Four patients had pneumothoraces after drain removal requiring further chest drain insertion. Five patients had superficial drain site infections. A single patient had to have a suture inserted at a local hospital owing to leakage from the drain site. CONCLUSIONS: The use of pursestring sutures in thoracic surgery is an outdated practice that causes not only unsightly scars but is also associated with increased pain. Furthermore, these unnecessary pursestring sutures place a burden on the patient and health care system to have them removed.

A lateral costal artery complicating video-assisted thorascopic surgery (VATS) pleurectomy.

The lateral costal artery is a rare variant arising from the internal thoracic artery (ITA). It has been associated with steel syndrome after coronary artery bypass using the ITA as a conduit. Clinically, it is under-reported in the literature. We report the presence of a prominent lateral costal artery, coursing below the diaphragm, discovered during video-assisted thorascopic surgery pneumothorax surgery and preventing parietal pleurectomy.

Simulator Teaching of Cardiopulmonary Bypass Complications: A Prospective, Randomized Study.

OBJECTIVE: Complications of cardiopulmonary bypass (CPB) are rare, but life-threatening events that need prompt and rehearsed actions involving a team. This is not adequately taught to cardiothoracic surgical trainees. The objective of this study was to assess the knowledge of cardiothoracic trainees required to manage these events after simulation-based vs. lecture-based teaching. PARTICIPANTS AND DESIGN: Totally, 17 cardiac surgical trainees with no formal teaching in intraoperative complications of CPB management were randomly assigned by computer to either a study group receiving simulation-based complications of CPB teaching via the Orpheus simulator (n = 9) or a control group receiving complications of CPB teaching via a lecture (n = 8). Each subject undertook a written test comprising 20 multiple choice questions on complications of CPB before and after teaching. Trainees were then asked to rate their satisfaction with each session from 1 to 5, with 5 being most satisfied. SETTING: St George Simulation and Clinical Skills Laboratory, St George's Hospital, London. RESULTS: There was no significant difference in the pretest scores between the 2 groups (p = 0.29). After teaching, both groups showed a statistically significant improvement in their knowledge (p < 0.05). The trainees in the simulation group performed better than the lecture-based group; however, this was not statistically significant (p = 0.21). Satisfaction levels in both the lecture session and the simulation session were very high with means of 4.4/5 and 4.8/5, respectively. CONCLUSION: Despite the familiarity with CPB during surgery, the simulation group performed at least as well as the lecture group. Cardiothoracic trainees would benefit from formal teaching of complications of CPB management via either learning modality being incorporated into their training.