Binocular stereo-navigation for three-dimensional thoracoscopic lung resection

BACKGROUND: This study investigated the efficacy of binocular stereo-navigation during three-dimensional (3-D) thoracoscopic sublobar resection (TSLR). METHODS: From July 2001, the authors’ department began to use a virtual 3-D pulmonary model on a personal computer (PC) for preoperative simulation before thoracoscopic lung resection and for intraoperative navigation during operation. From 120 of 1-mm thin-sliced high-resolution computed tomography (HRCT)-scan images of tumor and hilum, homemade software CTTRY allowed sugeons to mark pulmonary arteries, veins, bronchi, and tumor on the HRCT images manually. The location and thickness of pulmonary vessels and bronchi were rendered as diverse size cylinders. With the resulting numerical data, a 3-D image was reconstructed by Metasequoia shareware. Subsequently, the data of reconstructed 3-D images were converted to Autodesk data, which appeared on a stereoscopic-vision display. Surgeons wearing 3-D polarized glasses performed 3-D TSLR. RESULTS: The patients consisted of 5 men and 5 women, ranging in age from 65 to 84 years. The clinical diagnoses were a primary lung cancer in 6 cases and a solitary metastatic lung tumor in 4 cases. Eight single segmentectomies, one bi-segmentectomy, and one bi-subsegmentectomy were performed. Hilar lymphadenectomy with mediastinal lymph node sampling has been performed in 6 primary lung cancers, but four patients with metastatic lung tumors were performed without lymphadenectomy. The operation time and estimated blood loss ranged from 125 to 333 min and from 5 to 187 g, respectively. There were no intraoperative complications and no conversion to open thoracotomy and lobectomy. Postoperative courses of eight patients were uneventful, and another two patients had a prolonged lung air leak. The drainage duration and hospital stay ranged from 2 to 13 days and from 8 to 19 days, respectively. The tumor histology of primary lung cancer showed 5 adenocarcinoma and 1 squamous cell carcinoma. All primary lung cancers were at stage IA. The organs having metastatic pulmonary tumors were kidney, bladder, breast, and rectum. No patients had macroscopically positive surgical margins. CONCLUSIONS: Binocular stereo-navigation was able to identify the bronchovascular structures accurately and suitable to perform TSLR with a sufficient margin for small pulmonary tumors

A novel and simple method for identifying the lung intersegmental plane with an infrared thermography

25th WSCTS Annual Meeting and Exhibiotion 2015 2015年09月21日 Edinburgh, Scotlan

A novel and simple method for identifying the lung intersegmental plane with an infrared thermography

25th WSCTS Annual Meeting and Exhibiotion 2015 2015年09月21日 Edinburgh, Scotlan

ダイガク ノ カンリ エイヨウシ キョウイク ニオケル タショクシュ キョウドウ エノ リカイ ト ショクギョウテキ アイデンティティ ケイセイ オ ウナガス プロジェクト ガクシュウガタ キョウイクホウ ノ ケントウ

目的：「専門職ネットワーク演習」でのプロジェクト学習型教育法導入が多職種協働の意義を理解し職業的アイデンティティ（PI）形成促進に有効か検証した。方法：プロジェクト学習型の授業形態及び現場の管理栄養士と対話するフィールドワークを導入した。医師・看護師等と協働する臨床栄養、調理師等と協働する給食及びトレーナー等と協働するスポーツ栄養の各職場を想定し学生主体でテーマを決めた。ワークシート（WS）、最終レポート、リフレクションシート（RS）を用いて質的・量的に分析した。結果：WSの回答内容は授業２回より14回目で管理栄養士のネットワーク、連携の理由、必要な能力について量的・質的に充実した。最終レポートでは「学ぶ」と「自分」「働く」が共起し、RSでは「考える」と「連携」「必要」「知る」が共起し、自己評価では「他職種協働の意義・難しさ」の理解が３点満点であった。結論：本演習は多職種協働の意義を理解し、専門的知識・技能・態度を高める努力の必要性を学び、管理栄養士としてのPI形成に役立ったと考えられる。今後は他職種の理解や協働する技術の習得を促す教育内容の充実を図るため授業計画の検討が必要である。Objective：In the “Professional Network Exercise,” we adopted a new project-based learning program in which students decided their own theme: plan and work with small groups, or conduct fieldwork to interact with professional registered dietitians. We discussed whether this program was effective for the students’ realizing the purpose of interprofessional collaboration and promoting the formation of a professional identity as a registered dietitian.Methods：Quantitative and qualitative analyses were conducted for eight students, using class worksheets, final reports, and reflection sheets.Results：Judging from the worksheets, qualitative and quantitative improvements were seen in students in the second-to-last class regarding knowledge of the registered dietitian network; the reason why interprofessional collaboration is necessary; and the abilities needed to collaborate with other professionals. In the final reporting document, “Learn” co-occurred with “Self” and “Work.” On the reflection sheet, “Thinking” co-occurred with “Collaboration,” “Necessity,” and “Knowing.” Among the 25-item questionnaire for self-assessment in the reflection sheet, the highest average score was three out of three, which was detected in “Understanding importance of collaborating with other professionals” and “Understanding difficulty of collaborating with other professionals.”Conclusion：This exercise reinforced the level of understanding on the significance of interprofessional collaboration, and the abilities necessary for such collaboration. Students learned the specialized knowledge, skills, and attitudes required to be registered dietitians, and the need for further efforts to obtain them. It was also useful for forming a professional identity as a registered dietitian. However, in order to continue this educational program while maintaining its quality, further discussion about the program itself and the evaluations that follow will be necessary