Thoracoscopic Correction of Esophageal Atresia: Training in Rabbits Provides Valuable Surgical Expertise and Shortens the Learning Curve

Abstract

Background

: Thoracoscopic correction of esophageal atresia in neonatal infants presents severe surgical challenges, because the procedure requires highly specialized skills and great experience in endosurgery of the esophagus. However, the number of these patients is usually small, and additional training in an animal laboratory seems essential.

Materials and Methods

: We developed a thoracoscopic training model for pediatric surgeons to perform esophageal anastomosis in rabbits and investigated the feasibility and learning curve in such an experimental setting. New Zealand white rabbits with a mean body weight of 3.3 kg were used. In a four-port technique, employing 2.7-mm instruments, right-sided thoracoscopy was performed to expose and cut the esophagus. Both stumps retracted spontaneously. An orogastric tube was passed through the proximal stump, and the distal part was pulled up and intubated with the tube. Single 5-0 Prolene sutures were placed to complete the anastomosis.

Results

: These experiments allowed consecutive development of technical details and the surgeon's skills to complete an esophageal anastomosis. Moreover, specific intraoperative complications were encountered and managed.

Conclusion

: The rabbit model represents a useful tool to prepare a pediatric surgical team for the thoracoscopic correction of esophageal atresia in newborn infants.