Learning of VATS right lower lobe anterior-basal segmentectomy (S8) on a 3D printed simulator

Abstract

Background: Thoracic Surgery has dramatically evolved over the past 15 years with a switch in practice from exclusively open to a majority of minimal invasive approaches for the management of non-small cell lung cancer but also metastasis. For these indications, segmentectomies have become more popular and have made an important comeback in the field. The current practice therefore represents a challenge in the capacity of trained surgeons to teach these technically demanding surgeries to trainees in a safe way.Here, we report our experience with 3D printed lung model simulators for the teaching of right lower lobe anterior-basal segmentectomy (S8).Methods: We used 3D silicone printed lungs with an anatomy showing bronchis, veins and arteries up to the segmental level. With a weekly training protocol consisting of two residents supervised by a fellow and a staff surgeon, we worked the practical approach of minimal invasive right lower lobe anterior-basal segmentectomy (S8). Using the same instruments as in the operative theater and doing all dissection with the Harmonic ® shears, we were able to perform, in a way comparable to a procedure in patients, the steps of segment 8 resection. We recorded the procedure, illustrated the anatomy and assessed the satisfaction of trainees with this approach.Results: The video of a 3-port VATS right lower lobe anterior-basal segmentectomy (S8) in a 3D printed silicone model is provided. We choose a trans-fissure approach where the interlobar artery was identified followed by the isolation and stapling of A8, B8 and V8. The parenchyma was then stapled along the intersegmental plan to extract the segment. The approach was satisfactory for residents who found the exercise useful to train thoracoscopic movements, to understand anatomy and the stepwise approach.Conclusions: Simulation approaches are useful for the teaching of residents and could be a useful tool to integrate to the curriculum of trainees.