The Flat Lung Model
The flat lung model is a disposable training tool designed for deliberate practice in Video-Assisted Thoracic Surgery. It features exercises targeting basic and intermediate VATS skills, structured to support proficiency-based progression.
Each exercise includes metrics and evaluation reports to facilitate structured learning and skill mastery. These exercises can be utilized to:
- Master new skills.
- Refresh skills after a break.
- Warm up before attempting more advanced exercises.
Top Surface
The top surface of the flat lung model is covered with a white film featuring printed markings that outline seven core VATS skills exercises and their variations.
- SarajevoXXIV Focuses on mastering fundamental VATS skills, including moving, rotating, opening, and closing instruments, controlling the endoscopic camera’s direction, proximity, and horizon, and utilizing the 30-degree endoscope.
- Grasping Develops two-handed VATS instrumentation skills, teaching simultaneous use of both hands for effective retraction and exposure.
- Suturing Provides thoracoscopic training for interrupted and running sutures.
- Harmonic-Energy Develops control of a non-articulated straight endoscopic instrument such as harmonic shears, emphasizing proper feeding of lung tissue into the instrument’s jaws.
- Endo-Cutter Trains surgeons to handle the endo-cutter precisely, emphasizing tissue placement in the jaws and efficient articulation.
Bottom Surface
The bottom surface of the flat lung model allows access to the embedded broncho-vascular structures and lymph nodes, which are utilized in intermediate-level VATS skills exercises.
- Harmonic-Energy Refines the use of harmonic shears and two-handed instrumentation for manipulating and dissecting lymph nodes and isolating broncho-vascular structures.
- Endo-Cutter Builds consistency in passing the endo-cutter behind broncho-vascular structures and efficiently utilizing its articulation.
Number of Ports
All exercises can be performed using three different configurations based on the number of ports utilized. Each configuration represents a variation of the exercise, presenting unique challenges.
Reducing the number of ports increases the difficulty of the exercise, as fewer approach angles introduce new challenges that require additional skills.
Step-by-step approach...
The best results are achieved by first mastering 3-4 port VATS, then progressing to 2-port VATS, and finally to uniportal VATS, allowing for gradual skill development and adaptation.
- 4 Ports. The most straightforward approach, with each of the three instruments placed in its own port.
- 2 Ports. With all three instruments sharing the utility port, additional skills are needed to avoid instrument clashing and to manage retraction for exposure with limited approach angles.
- Single Port. Positioning the camera above the instruments adds another layer of complexity.
When two or fewer ports are used, one of the instruments must be marked near the tip for identification during scoring.
Obligatory camera port...
The camera should never be moved from the anterior port just above the diaphragm, except in case of Uniportal VATS.
Recommended instruments
Each exercise requires specific VATS instruments and equipment, detailed in the Required Equipment Table
for easy reference and preparation.Supply
Packaging
- Large packaging: 30 pieces per package (34×34×47cm, 5.2kg)
- Small packaging: 5 pieces per package (33×11×15cm, 0.8kg)
Versions
3.4 may 2024 Numbers placed inside circles. Number 1 moved anteriorly with counter-clockwise numbering.3.3 sep 2023 Added nine lymph nodes embedded between broncho-vascular structures.
Grasping spots replaced by targets. Suturing exercise represented by squares.3.1 sep 2022 Added suturing exercises.3.0 sep 2022 Foam material with a top white film replaced silicone gel.
Redesigned eight embedded broncho-vascular structures.2.0 aug 2020 Redesigned seven embedded structures.
Targets numbered. Wedges made triangular.1.2 dec 2017 Added printed markings for grasping spots wedge resections.1.1 may 2017 Embedded seven broncho-vascular structures in a star-shaped configuration.1.0 may 2016 First model prototype constructed from silicone gel.