Basic Harmonic
The goal of the exercise is to place the lung into the jaws of the harmonic shears and position the blade precisely along each of the two marked lines in all four marked triangles (two anterior and two posterior).
Any order of lines or triangles can be attempted, and instruments may be inserted through any combination of the remaining three ports.
Introduction
This exercise focuses on developing control of a non-articulated, straight endoscopic pistol-grip instrument, with an emphasis on properly feeding lung tissue into the instrument's jaws.
- Instrument exchange presents a new challenge, involving the switch between the grasper and harmonic shears, and vice versa.
This exercise serves as excellent preparation for transitioning to the endo-cutter exercise, which involves handling a much heavier and more challenging device.
Feeding the Jaws
Planning
The first step is to decide which port will be used for retraction with the grasper and which port will be used to introduce the harmonic device.
Retraction
Next, the line is aligned with the selected port by positioning the grasper at a strategic spot and moving the lung into place.
Retraction and exposure are always achieved using two lung graspers, following the principles outlined in the grasping exercise. A larger bite can be used to stabilize the lung near the line.
Harmonic Shears...
Harmonic shears are not a lung grasper and should not be used to manipulate the lung.
Execution
Once optimal exposure is attained, one of the graspers is replaced by the harmonic shears and the blade positioned along the marked line.
To achieve that, the direction of the harmonic should be perfectly aligned with the line and at the same time also parallel to the surface of the lung.
Certain lines may align more easily with specific ports, but this might require holding the harmonic in the non-dominant hand.
Testing Alignment...
Before switching from grasper to harmonic, use the grasper to verify if the angle from the port is aligned to the surface of the lung and marked line.
Scoring and Feedback
The lung should be fed into the harmonic shears according to the following criteria:
- Surface Alignment. The blade must be perfactly aligned with the surface of the lung when feeding the jaws. Minor departures from alignment earn ½ point.
- Line Alignment. The blade of the harmonic must fully touch the marked line. If at least half of the blade touches the line, ½ point is awarded.
- Deformation. Lung should not be unnecessarily stretched or twisted.
- Alignment Test. A bonus is awarded if the grasper is used to verify the angle before switching to the harmonic shears.
Camera
- Horizon. The camera horizon must be leveled within a tolerance of ±10°.
- Target. The blade of the harmonic shears must be positioned within the outer target scoring area.
Penalties
The following errors result in penalties:
- Abuse. Manipulating the lung using harmonic shears or requiring excessive movement to align the instrument blade with the marked line.
- Injury. Any major injury to the lung results in an immediate game over.