The baseball diamond principle (BDP) is the conventional principle used for ports placement in video-assisted thoracic surgery (VATS). The triangle target principle (TTP) was introduced as an alternative principle where BDP is associated with difficulties especially in lung resections. We compared the task performance and surgeon's discomfort during some nonpulmonary VATS procedures between using the BDP and TTP in swine models.

Thirty-six nonpulmonary VATS procedures were done on swine models at the World Laparoscopy Hospital, Gurgaon, NCR Delhi, India, from 19th February 2013 to 23rd march 2014. The procedures are 12 VATS pericardial window, 12 esophagocardiomyotomy and 12 thoracic sympathectomy (6 using BDP and 6 using TTP of each procedure). The outcome measures were the execution time, the errors rate and the surgeon's discomfort.

Video-assisted thoracic surgery pericardial window using TTP took longer time to be executed with a mean difference of 93 seconds when compared to using BDP but the errors rates and surgeon's discomfort was similar between BDP and TTP. VATS esophagocardiomyotomy using BDP took longer time with a mean difference of 326.67 seconds but using the TTP was associated with more errors and surgeon's discomfort. In VATS thoracic sympathectomy using the BDP took longer time with a mean difference of 194 seconds, but the execution time data using BDP was not reproducible when validated statistically. The errors rates and surgeon's discomfort was similar between BDP and TTP.

Using baseball diamond principle appears to lead to better task performance and less Surgeon's discomfort during some nonpulmonary VATS procedures in swine models but there is need for studies with larger sample size. TTP use may be more favored during nonpulmonary VATS when stapling will be required.

Ismail AJ, Mishra RK. Comparing Task Performance and Comfort during Nonpulmonary Video-assisted Thoracic Surgery Procedures between the Application of the ‘Baseball Diamond’ and the ‘Triangle Target’ Principles of Port Placement in Swine Models. World J Lap Surg 2014;7(2):60-65.