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VATS In Practice: Room Organization, Instrumentation, Thoracoscopic Anatomy, Indications
P.D. Mayhew
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Operating room organization
With 2-4 surgeons, an endoscopic tower, an instrument table, one or two electrosurgical units as well as anesthesia personnel and equipment, a considerable logistical challenge is present during most minimally invasive surgical procedures. While many human centers now operate in custom-designed minimally invasive procedure suites, where ceiling mounted booms house most of the required components used in these procedures, these facilities are not widely available in veterinary medicine. Integrated minimally invasive surgery suites often have the advantage of incorporating multiple viewing screens allowing surgeons and surgical assistants to maintain a straight viewing angle to the area of interest and on to the viewing screen. The ability to always maintain this direct line of vision is key to maintaining good hand-eye control. As only one viewing screen is available in most operating rooms and is generally located on top of the endoscopic tower, the position of the tower is key.
Thoracoscopic procedures performed in dorsal recumbency usually involve placement of a subxiphoid telescope portal that is used to visualize more cranially located structures. Therefore, positioning the endoscopic tower and monitor at the head of the patient with the anesthesia machine and personnel moved slightly to one or the other side of the patient is recommended. It is helpful with patients in dorsal recumbency to not encumber the lower end of the operating table by draping in instrument tables or having cords attached in that location so that the surgeons can move freely around the caudal end of the dog. This can allow a surgeon to lean over the patient in order to handle surgical instrumentation entering through right and left-sided intercostal portals, if necessary, as well as allowing the surgeon an unobstructed path to move to either side of the patient if required. [...]
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Affiliation of the authors at the time of publication
University of California-Davis, Davis, USA
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