SarajevoXXIV Exercise

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The exercise consists of two steps:

  • Poke the numbers inside the designated circles with the tip of the instrument while keeping the jaws closed.
  • Open the instrument, rotate it, and bring it to the center of the view.

These steps must be repeated at each of the 16 points around the circumference of the flat lung, alternating between the right-hand and left-hand instruments:

  • Start at point No. 1.
  • Progress counter-clockwise.
  • Finish at point No. 16.

Introduction

This exercise focuses on developing fundamental skills essential for Video-Assisted Thoracic Surgery (VATS), including:

  1. Precise manipulation of instruments within the chest cavity.
  2. Rotating, opening, and closing surgical instruments with accuracy.
  3. Controlling the direction, proximity, and horizon of the endoscopic camera effectively.
  4. Proficient utilization of the 30° endoscope.
Mastering skills through individual practice... Each skill should initially be practiced individually. Once mastered, they can be combined into a complete exercise.

Scoring and Feedback

Poke

Poking
  • Direct Contact. The tip of the instrument (ring area) must rest on the number in the designated circle.
  • Alignment. The instrument’s jaws must be perpendicular to the lung’s surface. Proper alignment is confirmed when the instrument handle outside the chest is perfectly horizontal, with the rings for the fingers facing upward.
Instrument's curvature... Upward Curvature: Typically preferred as it minimizes rib contact and allows smoother instrument handling.
Downward Curvature. Results in a more horizontal shaft. This position hinders instrument movement by increasing contact with the ribs, similar to the challenges posed by rotating a 30° endoscope.

Open

Instrument opening and rotation
  • Center. The imaginary point in the center of the screen must lie directly between the instrument's two open jaws.
  • Parallel. The surface of the jaws must be precisely parallel to the direction of the camera view. This can also be verified by checking the plane of the instrument handle outside, which must be vertical, with the rings for the fingers facing left/right.
Instrument position... Turning the instrument’s curvature toward the camera brings its jaws closer to the lens, making centering and rotation control easier. Instrument opening... When wrist mobility limits instrument rotation, holding the instrument from the opposite side can provide better control and ease of movement.

Camera

Horizon. The camera horizon must be leveled within a tolerance of ±10°.

Target. During poking, the camera must target the poked number, which must lie within the inner target scoring area to earn full points. If the number lies within the intermediate target area, it earns ½ point.