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Use of Hybrid techniques to improve the learning curve for VATS
narendra agarwal, shaiwal khandelwal, kamran Ali, mohd fauzi, ali zamir khan, ali zamir khan.
medanta the medicity, gurgaon, India.

OBJECTIVE: Video-assisted thoracoscopic surgeries (VATS) have been gaining importance as the gold standard technique for various thoracic resections. this article presents the use of videoscope along with mini thoracotomy to perform technically difficult VATS surgeries and improve the learning curve for performing VATS
METHODS: A series of 1043 VATS procedures were performed between 2011-2015. Out of which 103 cases were performed as a hybrid technique where mini thoracotomy was made along with videotelescope at the thoracoscopic port. The advantages of this dual access were ease in instrumentation, visualization, lighting, retraction and hand-eye coordination. In addition, this technique allows immediate access under direct vision for urgent control of bleeding, which can be difficult using a conventional thoracoscopic approach.
RESULTS: Out of 103 cases 74 were males and 29 were females with the mean age of 54 years (ranging from 22-82). The cases performed were anatomical anamoly, severe dense adhesions, identifications of very small/deep seated malignant lesions for biopsy, lobectomy, decortication, pneumonectomy, sleeve resections for carcinoid, bronchoplasty. The mean operative time was 92 minutes. There were no conversions to conventional thoracotomy. Mean hospital stay was 3-4 days. Chest tube duration was 2-3 days. There was no mortality. The results were favourably compared to conventional VATS procedures and showed a feasibility of the hybrid technique.
CONCLUSIONS: The results suggest that every open thoracic surgery should have a thoracoscopic port for better visualization of anatomy, technique and hand-eye coordination which will further enhance the learning curve for VATS.

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