A randomized, prospective, comparative trial of a variable-angle versus fixed-angle endoscope for exploratory...

Area of Science:

• Veterinary Surgery
• Thoracoscopy
• Surgical Instrumentation

Background:

• Thoracoscopic exploration in veterinary medicine often faces challenges with visualization, particularly due to lung movement.
• Traditional fixed-angle endoscopes (FAE) have limitations in adapting to the complex three-dimensional anatomy of the thoracic cavity.
• Improving surgical efficiency and visualization is crucial for successful minimally invasive thoracic procedures.

Purpose of the Study:

• To compare the efficacy of a variable-angle endoscope (VAE) versus a traditional fixed-angle endoscope (FAE) for canine thoracoscopic exploration.
• To evaluate the impact of lung ventilation status on the performance of both endoscope types.
• To assess the time efficiency and accuracy of anatomical identification using VAE and FAE.

Main Methods:

• A randomized, prospective, comparative study was conducted using five fresh canine cadavers.
• Twelve predetermined anatomical locations were identified in each thorax.
• Two veterinary surgeons performed thoracoscopic evaluations using both FAE (30°) and VAE (0°-120°) under conditions with and without mechanical lung ventilation, with randomized procedural order.

Main Results:

• The variable-angle endoscope (VAE) significantly decreased cumulative thoracoscopic exploration time compared to the fixed-angle endoscope (FAE) (112 seconds difference, P=.029).
• VAE use shortened the time to identify specific anatomical locations when lung ventilation was active, acting as an alternative to one-lung ventilation.
• Failure to identify anatomical locations was less frequent with the VAE than the FAE, indicating improved visualization and efficiency.

Conclusions:

• The rigid variable-angle endoscope (VAE) enhances surgeon efficiency by reducing cumulative exploration time in canine thoracoscopy.
• VAE offers a viable alternative to one-lung ventilation, mitigating visual obstructions caused by lung movement.
• This cadaveric study suggests that VAE use, potentially combined with one-lung ventilation, may improve overall surgeon efficiency in exploratory thoracoscopy.