Thoracoscopic approach of the internal mammary artery (IMA): A training model in pigs

Abstract

Endoscopic internal mammary artery (IMA) approach represents a well-established procedure in coronary bypass surgery. However, such techniques require highly trained skills that need to be mastered in experimental models before taken into the clinic. To attain such skills, our aim was to develop a training model of thoracoscopic approach for harvesting of the IMA in pig. Ten pigs of either sex, weighing 20-28 kg, were used. The thoracic cavity was accessed with the animal in a lateral decubit position, through two ports of 10 mm and 1 of 5 mm, inserted on the anterior and posterior axillary lines immediately below the infrascapular angle into the pleural cavity, and a 30 degrees Hopkins II telescope. The internal mammary artery (IMA) was identified and dissected from its origin in the subclavian artery until its distal part where it becomes the deep superior epigastric artery. Afterward, the arterial segment was clipped and harvested. The mean operative time was 73 min. Postoperative survival at 72 hours was 100% and 90% at 4 weeks. A mean length of 3.2 cm of IMA graft was obtained (2.8-4 cm). The pig IMA has no intercostal branches; thus, the mobilization of the vessel being greatly facilitated. The procedure has two critical steps: the proper trocar insertion and the dissection of the middle one-third of the IMA. Endoscopic-assisted IMA, harvesting in pigs, represents a useful tool for training in minimally invasive heart surgery and supports further development toward other clinical applications.

Generation of suppressive blood cells for control of allograft rejection

“…The pigs were kept at the animal facility of the Pius Branzeu Center for Laparascopic Surgery and Microsurgery of the Victor Babes University of Medicine and Pharmacy, Timisoara, Romania. All operations were performed under general anaesthesia as previously described [7].…”

Porcine model for free-flap breast reconstruction training

“…The recipient vessels, which are mostly used for freeflap breast reconstruction, are the ITA and ITV. 15,16 Several authors used the porcine ITA for learning purposes 17,18 or to test new surgical techniques in cardiac surgery. 19 Recently, Nistor et al proved that the pig's ITA and ITV represent an optimal model for free-flap breast reconstruction training.…”

Comparison of the internal thoracic artery flow dissected by video endoscopy or conventional technique

“…Studies have shown that swine models are ideal for in-vivo training of MI surgical techniques 2,18,[22][23][24] . A standardized experimental model in pigs represents a useful tool for the training of surgeons to develop their skills.…”

“…A standardized experimental model in pigs represents a useful tool for the training of surgeons to develop their skills. The model developed by Jiga et al 22 seems to have a rapid learning curve, requiring minimal experience in laparoscopic surgery, serving as a practical preparation for performing more complex procedures, such as dissection of the ITA for MI cardiac surgery. However, this model has the disadvantage that the dissection of the ITA occurs only in the proximal third, a relatively small portion (mean of 3.2 cm in length), and is devoid of branches in swine.…”