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Eur J Cardiothorac Surg 2005;27:307-312
© 2005 Elsevier Science NL

Triangle target principle for the placement of trocars during video-assisted thoracic surgery

Department of Surgery (II), University of Fukui, Faculty of Medical Sciences, 23-3 Shimoaizuki, Matsuoka Fukui 911-1104, Japan

Received 10 April 2004; received in revised form 11 October 2004; accepted 19 October 2004.

^* Tel.: +81 776 61 3111x2350; fax: +81 776 61 8114. (E-mail: masato{at}fmsrsa.fukui-med.ac.jp).

Objective: The baseball-diamond principle is generally used for trocar placement during video-assisted thoracic surgery; however, we are unable to treat all peripheral lung lesions using this principle. Therefore, we have developed another method for determining trocar placement based on a modification of the conventional principle. We have termed this method the triangle target principle. This report describes the instrument positioning that we now use for many video-assisted thoracic surgical procedures. Methods: We position 3 trocars in an equilateral triangle, with the target lesion at the apex. One vertex of the base becomes the site of the first trocar placement for introduction of the thoracoscopic camera. Another vertex of the base becomes the site for the second trocar for forceps or the endoscopic stapler. The third trocar is for forceps and is inserted to create the vicinity of target lesion. Four types of the triangle target principle were developed according to sites of the target lesion. Results: Between January 2000 and December 2002, we used this principle for 161 patients who underwent video-assisted thoracic surgery and all intrathoracic lesions were accessible except in 3 patients requiring intraoperative modifications. Conclusions: We conclude that video-assisted thoracic surgery by this principle is more effective and easier than the conventional principle to treat intrathoracic disease.

Key Words: Video-assisted thoracic surgery (VATS) • Trocar placement • Pneumothorax • Benign lung tumor

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