Construct Validation: Simulation of Thoracoscopic Intrathoracic Anastomosis

Fabian, Thomas; Glotzer, Owen; Bakhos, Charles

doi:10.4293/jsls.2015.00001

Cited by 9 publications

(6 citation statements)

References 8 publications

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“…We set out to confirm the safety of blind NGT placement, first in a well-described simulation model, and then in our esophagectomy patients. 12 No damage was observed at the staple line following NGT placement. Accurate anatomical conditions were reconstructed to the best of our abilities by setting the porcine model into a tissue model that transitioned from the chest to the abdomen in a non-uniform manner, across a simulated hiatus using the VATS simulator.…”

Section: Discussionmentioning

confidence: 94%

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Blind nasogastric tube advancement following esophagectomy

Harris¹,

Fabian²

2022

GHOA

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Background: Esophagectomy remains the primary curative treatment for esophageal cancer. Postoperatively, surgeons routinely drain the gastric conduit with a nasogastric tube (NGT). This tube is removed after the anastomosis is thought to have healed. Occasionally, patients require replacement of the NGT. Many surgeons are hesitant to place an NGT blindly due to perceived risk of harm to the anastomosis or gastric conduit. Our investigation was carried out to clarify whether the concern of blind NGT placement is justified.Methods: In phase one, a porcine model of an Ivor-Lewis esophagectomy with a stapled end to side anastomosis was constructed and placed within a thorax model. Nasogastric tube advancement followed by endoscopy with water submersion was conducted to assess for damage or anastomotic leak. The second phase assessed clinical outcomes of minimally invasive Ivor-Lewis esophagectomy with mechanical end to side anastomosis in patients who underwent blind NGT placement at the conclusion of their procedure. Results:No mucosal injuries, anastomotic leaks or perforations were observed in the model. No injuries were identified to the gastric conduit staple line. Intermittent catching or curling at the anastomosis occasionally occurred but never resulted in injury. Leak test with endoscopic insufflation was negative. Sixty-seven post-esophagectomy patients at a single institution between January 2013 and December 2015 were included in the second phase of our study. Anastomotic leak occurred in four (6%) patients. No gastric leaks, and no gastric tip necrosis occurred. One (1.5%) mortality occurred.Conclusions: Blind NGT placement did not harm the gastric staple line or cause mucosal injury in the esophagectomy model. No significant anastomotic leaks or gastric conduit leaks were identified in the clinical series. Blind NGT placement following stapled end to side intrathoracic anastomosis is safe and appropriate following esophagectomy.

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Section: Discussionmentioning

confidence: 94%

“…Lansing, MI). 12 Esophagectomy with end to side anastomosis was constructed with a 25 EEA (Medtronic, Minneapolis, MN) stapler. Once created, blind NGT placement was performed.…”

Section: Methodsmentioning

confidence: 99%

Blind nasogastric tube advancement following esophagectomy

Harris¹,

Fabian²

2022

GHOA

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“…19 A thoracoscopic intrathoracic anastomosis simulator using porcine tissue is also available and allows creating the anastomosis faster and with better quality after multiple repetitions. 20 Orringer et al 21 have recently described a cervical esophagogastric anastomosis simulator using silicone esophageal and gastric tip castings that permit the construction of a stapled side-to-side esophagogastric anastomosis guided by an illustrated curriculum.…”

Section: Simulation In Foregut Surgery: Current Simulatorsmentioning

confidence: 99%

Simulation for Foregut and Bariatric Surgery: Current Status and Future Directions

Schlottmann

Herbella

Patti

2021

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Simulation offers the opportunity to practice in a safe, controlled, and standardized environment. Surgical simulation, in particular, is very attractive because it avoids learning and practicing surgical skills in the operating room. Many simulators are currently available such as box-lap trainers, virtual-reality platforms, cadavers, live animals, animal-based tissue blocks, and synthetic/artificial models. Endoscopic interventions can be practiced with high-fidelity virtual simulators. Box-lap trainers help practicing basic laparoscopic skills. Cadavers and live animals offer realism to train entire foregut and bariatric procedures. However, limited availability and high expenses often restrict their use. Ex vivo simulators with animal tissue blocks have been recently developed and appear to be a realistic and cost-effective alternative. Three-dimensional printing and real-time navigation systems have also emerged as promising training tools. Overall, further efforts are needed to develop a formal simulation curriculum with validated simulators for foregut and bariatric surgery.

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“…1,2 Although certain contributors to anastomotic breakdown, such as previously irradiated tissue and pre-existing patient comorbidities, are rarely modifiable at the time of an operation, surgical technique may be optimized before entering the operating theater through high-fidelity simulation training. 3 Contemporary simulation training in cardiothoracic surgery ranges from simple bench prototypes to mixed-reality programs and cadaveric models. 4 The majority focus on microvascular anastomosis, as well as bronchoscopic and endoscopic techniques.…”

Section: Commentary: Practice Makes Perfect In Cervical Esophagogastric Anastomosismentioning

confidence: 99%

“…Many of these simulation-based curriculums have been reported to not only have a high fidelity to live surgery but also to impart skill sets to produce safer surgeons. [3][4][5][6] In addition, in the current environment, residents have limitations imposed by duty hours, and attendings must be present for key portions of the procedures. Thus, true independence in the operating room has seen an overall decline from previous generations of trainees.…”

mentioning

confidence: 99%