Starfish Success: Thoracic Tumour Resection With Novel Use Of Starfish Heart Positioner
Lauren Bidois, MBChB, Harsh Singh.
Christchurch Hospital, Christchurch, New Zealand.
Background: Adequate visualisation within the hemithorax is a vital component of successful video-assisted thoracoscopic surgery (VATS), allowing for complete tumour resection and to reduce risk of conversion to open thoracotomy. Additionally, the ability to manipulate tissues in order to provide this ample visualisation is paramount. In VATS, this tissue mobility is already hampered by the limited angles afforded by the intercostal spaces, and this in combination with a large tumour (>5cm) can mean standard VATS graspers may not lend themselves to a quick and technically easy operation. We present a successful case of using an improvised suction instrument to improve visualisation and tissue manipulation. Methods: A Starfish Heart Positioner was combined with thoracoscopic suction in a novel manner to retract and excise a 58x44x54mm fibrous pleural tumour in a 49-year-old patient. 
Results: We had an excellent surgical resection result and a significant reduction in operating time, due to enhanced visualisation and mobility afforded by our instrument. Conclusion: The Starfish Heart Positioner in combination with thoracoscopic suction is a viable grasping and retraction instrument for use in VATS tumour excision, however, further assessment is required before using it on other tissues within the thorax. 
Legend: (1) Starfish Heart Positioner combined with thoracoscopic suction
(2)Intra-operative view of improvised starfish suction instrument in use to retract a large thoracic tumour
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