- Email: [email protected]
Assistant Training Using Videothoracoscopy
1636
CORRESPONDENCE
Giuseppe Santarpino, MD Paracelsus Medical University Klinikum N€ urnberg Breslauerstrasse 201-90471 Nuremberg, Germany email: [email protected]
References 1. Tanaka A, Tuladhar SM, Onsager D, et al. The subclavian intraaortic balloon pump: a compelling bridge device for advanced heart failure. Ann Thorac Surg 2015;100:2151–8. 2. Raman J, Loor G, London M, Jolly N. Subclavian artery access for ambulatory balloon pump insertion. Ann Thorac Surg 2010;90:1032–4. 3. Onorati F, Impiombato B, Ferraro A, et al. Transbrachial intraaortic balloon pumping in severe peripheral atherosclerosis. Ann Thorac Surg 2007;84:264–6. 4. Onorati F, Bilotta M, Pezzo F, et al. Transbrachial insertion of a 7.5-Fr intra-aortic balloon pump in a severely atherosclerotic patient. Crit Care Med 2006;34:2231–3.
Reply To the Editor: We agree with Dr Onorati and colleagues [1] regarding the transbrachial intraaortic balloon pump. It is a valuable procedure in patients who might have difficulty with vascular access and for whom limited ambulation is preferable to the strict bed rest required by the femoral intraaortic balloon pump. The transbrachial approach can be done percutaneously and with minimal complications. However, our approach [2] is designed for long-term implant when the focus is full physical rehabilitation. It does require anesthesia and a graft but it allows arm exercises, full mobility, and muscle strengthening training. In summary, the transbrachial and subclavian approaches are complementary and allow for expanded use of counterpulsation in circulatory failure. Valluvan Jeevanandam, MD Department of Cardiac and Thoracic Surgery University of Chicago Medicine 5841 S Maryland Ave, MC 5040, Ste E500 Chicago, IL 60637 email: [email protected]
References
2. Tanaka A, Tuladhar SM, Onsager D, et al. The subclavian intraaortic balloon pump: a compelling bridge device for advanced heart failure. Ann Thorac Surg 2015;100:2151–8.
Assistant Training Using Videothoracoscopy To the Editor: We read with interest the article by Meyerson and colleagues [1], and we support the conclusion of their research wholeheartedly. We have been performing video-assisted thoracic surgery (VATS) lobectomy successfully in our clinic for the past 4 years. Our assistant training program includes VATS training. In our training practice, visualization is the first step. During this step, the assistants learn 3-dimensional evaluation through a single port and improve their skills for using the endoscopic instruments. This step takes about 6 months. Thereafter the assistant is allowed to use the camera and instruments in endoscopic thoracic sympathectomy procedures through a second port, which develops the sense of coordination of the instruments. These procedures develop the assistant’s self-confidence. The next 6 months includes the use of a stapler for apical resections in pneumothorax cases through 2 ports. As the last step of our training, VATS lobectomy with multiport and utility thoracotomy incisions, without using costal separators, provides the dissection of bronchovascular branches with a high-definition display. It facilitates the safe use of the stapler. By providing good visualization, the camera can be used through different ports to give a perfect view. We have trained 5 thoracic surgeons in the preceding manner, and all of our trainees are regularly practicing minimally invasive operations using VATS. We are of the opinion that even half-day courses for physician assistants will be helpful for VATS lobectomy to be adopted in the our thoracic surgery community. Murat Oncel, MD Guven Sadi Sunam, MD Huseyin Yildiran, MD Department of Thoracic Surgery Selcuk University Medical Faculty Alaeddin Keykubat Kamp€ us€ u 42000, Konya, Turkey email: [email protected]
Reference 1. Meyerson SL, Balderson SS, D’Amico TA. Training assistants improves the process of adoption of video-assisted thoracic surgery lobectomy. Ann Thorac Surg 2015;100: 401–6.
MISCELLANEOUS
1. Onorati F, Faggian G, Santarpino G. Transbrachial intraaortic balloon pumping: the forgotten vessel? (letter). Ann Thorac Surg 2016;101:1635–6.
Ann Thorac Surg 2016;101:1628–36
Ó 2016 by The Society of Thoracic Surgeons Published by Elsevier
0003-4975/$36.00
CORRESPONDENCE
Giuseppe Santarpino, MD Paracelsus Medical University Klinikum N€ urnberg Breslauerstrasse 201-90471 Nuremberg, Germany email: [email protected]
References 1. Tanaka A, Tuladhar SM, Onsager D, et al. The subclavian intraaortic balloon pump: a compelling bridge device for advanced heart failure. Ann Thorac Surg 2015;100:2151–8. 2. Raman J, Loor G, London M, Jolly N. Subclavian artery access for ambulatory balloon pump insertion. Ann Thorac Surg 2010;90:1032–4. 3. Onorati F, Impiombato B, Ferraro A, et al. Transbrachial intraaortic balloon pumping in severe peripheral atherosclerosis. Ann Thorac Surg 2007;84:264–6. 4. Onorati F, Bilotta M, Pezzo F, et al. Transbrachial insertion of a 7.5-Fr intra-aortic balloon pump in a severely atherosclerotic patient. Crit Care Med 2006;34:2231–3.
Reply To the Editor: We agree with Dr Onorati and colleagues [1] regarding the transbrachial intraaortic balloon pump. It is a valuable procedure in patients who might have difficulty with vascular access and for whom limited ambulation is preferable to the strict bed rest required by the femoral intraaortic balloon pump. The transbrachial approach can be done percutaneously and with minimal complications. However, our approach [2] is designed for long-term implant when the focus is full physical rehabilitation. It does require anesthesia and a graft but it allows arm exercises, full mobility, and muscle strengthening training. In summary, the transbrachial and subclavian approaches are complementary and allow for expanded use of counterpulsation in circulatory failure. Valluvan Jeevanandam, MD Department of Cardiac and Thoracic Surgery University of Chicago Medicine 5841 S Maryland Ave, MC 5040, Ste E500 Chicago, IL 60637 email: [email protected]
References
2. Tanaka A, Tuladhar SM, Onsager D, et al. The subclavian intraaortic balloon pump: a compelling bridge device for advanced heart failure. Ann Thorac Surg 2015;100:2151–8.
Assistant Training Using Videothoracoscopy To the Editor: We read with interest the article by Meyerson and colleagues [1], and we support the conclusion of their research wholeheartedly. We have been performing video-assisted thoracic surgery (VATS) lobectomy successfully in our clinic for the past 4 years. Our assistant training program includes VATS training. In our training practice, visualization is the first step. During this step, the assistants learn 3-dimensional evaluation through a single port and improve their skills for using the endoscopic instruments. This step takes about 6 months. Thereafter the assistant is allowed to use the camera and instruments in endoscopic thoracic sympathectomy procedures through a second port, which develops the sense of coordination of the instruments. These procedures develop the assistant’s self-confidence. The next 6 months includes the use of a stapler for apical resections in pneumothorax cases through 2 ports. As the last step of our training, VATS lobectomy with multiport and utility thoracotomy incisions, without using costal separators, provides the dissection of bronchovascular branches with a high-definition display. It facilitates the safe use of the stapler. By providing good visualization, the camera can be used through different ports to give a perfect view. We have trained 5 thoracic surgeons in the preceding manner, and all of our trainees are regularly practicing minimally invasive operations using VATS. We are of the opinion that even half-day courses for physician assistants will be helpful for VATS lobectomy to be adopted in the our thoracic surgery community. Murat Oncel, MD Guven Sadi Sunam, MD Huseyin Yildiran, MD Department of Thoracic Surgery Selcuk University Medical Faculty Alaeddin Keykubat Kamp€ us€ u 42000, Konya, Turkey email: [email protected]
Reference 1. Meyerson SL, Balderson SS, D’Amico TA. Training assistants improves the process of adoption of video-assisted thoracic surgery lobectomy. Ann Thorac Surg 2015;100: 401–6.
MISCELLANEOUS
1. Onorati F, Faggian G, Santarpino G. Transbrachial intraaortic balloon pumping: the forgotten vessel? (letter). Ann Thorac Surg 2016;101:1635–6.
Ann Thorac Surg 2016;101:1628–36
Ó 2016 by The Society of Thoracic Surgeons Published by Elsevier
0003-4975/$36.00