Simulation of VATS Lobectomy Using a Lifelike Chest Model

Background
A life-sized chest model with a lifelike texture was developed to simulate thoracoscopic surgery. Video-assisted thoracoscopic surgery (VATS) for right lower lobectomy was performed using the model.

Materials
This novel model was developed using a computed tomography (CT) data obtained from a healthy Japanese man. A mold of the chest organs was created by three-dimensional printing, and then used to cast the model using industrial methods. The major blood vessels and bronchi within the lungs are anatomically correct and continuous with the mediastinum, which was cast as a plate. The lung parenchyma was cast from polyvinyl alcohol foam and incudes water and air, which gives it a soft, elastic texture and renders it electrically conductive. The sensations of cutting, suturing, and surgical stapling are similar to live surgery. It is also possible to use powered instruments.

Methods
The model was placed in the left decubitus position on the operating table in the operating theater. All apparatus, instruments, and devices were the same as those used during actual surgery. Intercostal incisions were made as in VATS lobectomy, and a thoracoscope was inserted to view the intrathoracic anatomy. After dividing the pulmonary ligament with a LigaSure instrument, the major fissure was divided to expose the pulmonary artery. The surrounding tissues were cleared, and the pulmonary artery was taped and divided using an Endo GIA stapler. The right lower pulmonary vein was then exposed and divided using the Endo GIA stapler. After clearing the interlobar tissues, hilum, and mediastinal lymph nodes, the lower lobe bronchus was taped and divided using the Endo GIA stapler. The surgical procedure, including the usual maneuvers, was conducted in this novel, life-size model as in an actual VATS lobectomy.

Discussion
This novel chest model allows performing surgical maneuvers that simulate VATS lobectomy. Although anatomic detail is not precisely reproduced and no bleeding occurs, the model has the potential to replicate the circumstances of actual thoracoscopic surgery. It is convenient to use and is easily transportable to a laboratory or operating theater. From the standpoint of ethical and religious issues, using the model for VATS training avoids conventional training methods that rely on live animals and human cadavers.

Disclosure
This model was co-developed with FASOTEC Co. Ltd., Chiba, Japan.