Surgical Endoscopy

, Volume 23, Issue 8, pp 1882–1886

Preliminary results with a training program for thoracoscopic atrial fibrillation therapy

  • Francisco M. Sánchez-Margallo
  • Idoia Díaz-Güemes
  • Francisco J. Pérez
  • Miguel A. Sánchez
  • Beatriz Loscertales
  • Jesús Usón



Novel devices have been designed for the treatment of atrial fibrillation (AF) using minimally invasive approaches. This study aimed to determine the usefulness of a sheep model for training in cardiac surgical ablation using a minimally invasive approach in an experimental hands-on training course.


After initial training using a laparoscopic pelvic trainer, 15 sheep were subjected to surgery by six thoracic surgeons attending a hands-on thoracoscopic course. Dissection to the posterior wall of the pulmonary veins was followed by insertion of a microwave device around both the caudal cava vein and the pulmonary veins. The complications were recorded, and the effectiveness of the surgery was evaluated by complete deployment of the microwave device. The animals were killed after completion of the procedure.


Isolation of the cava vein and the pulmonary veins and placement of the microwave probe were performed successfully for 10 animals using a complete thoracoscopic approach. Two animals died during the procedure. The main complications of the procedure were hemorrhage and difficulty isolating the blood vessels using a minimally invasive procedure. After the training period, the thoracoscopic surgical maneuvers were accurate and reliable.


The technical feasibility of performing safe and efficient thoracoscopic placement of a microwave device in a sheep model was demonstrated in this study, suggesting that the results of this study are a useful contribution to the development of an animal model for surgical training and experimental cardiac surgeries.


Atrial fibrillation Cardiac surgical ablation Microwave device Ovine model Thoracoscopic training Thoracoscopy 


  1. 1.
    Nitta T (2005) Surgery for atrial fibrillation. Ann Thorac Cardiovasc Surg 11:154–158PubMedGoogle Scholar
  2. 2.
    Hirosawa K, Sekiguchi M, Kasanuki H, Kimata S, Kaneko N, Nakamura K, Aosaki M, Takahashi S, Kondo M (1987) Natural history of atrial fibrillation. Heart Vessels Suppl 2:14–23PubMedGoogle Scholar
  3. 3.
    Geidel S, Ostermeyer J, Lass M, Boczor S, Kuck KH (2003) Surgical treatment of permanent atrial fibrillation during cardiac surgery using monopolar and bipolar radiofrequency ablation. Indian Pacing Electrophysiol J 3:93–100PubMedGoogle Scholar
  4. 4.
    Fuster V, Ryden LE, Cannom DS et al (2007) ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: executive summary. Rev Port Cardiol 26:383–446PubMedGoogle Scholar
  5. 5.
    Koistinen J, Valtonen M, Savola J, Airaksinen J (2007) Thoracoscopic microwave ablation of atrial fibrillation. Interact Cardiovasc Thorac Surg 6:695–698PubMedCrossRefGoogle Scholar
  6. 6.
    Pruitt JC, Lazzara RR, Ebra G (2007) Minimally invasive surgical ablation of atrial fibrillation: the thoracoscopic box lesion approach. J Interv Card Electrophysiol 20:83–87PubMedCrossRefGoogle Scholar
  7. 7.
    Pruitt JC, Lazzara RR, Dworkin GH, Badhwar V, Kuma C, Ebra G (2006) Totally endoscopic ablation of lone atrial fibrillation: initial clinical experience. Ann Thorac Surg 81:1325–1330PubMedCrossRefGoogle Scholar
  8. 8.
    Poa L (2006) Thoracoscopic ablation for treatment of atrial fibrillation: a 2-port approach. Heart Surg Forum 9:E590–E591PubMedGoogle Scholar
  9. 9.
    Saltman AE (2007) Minimally invasive surgery for atrial fibrillation. Semin Thorac Cardiovasc Surg 19:33–38PubMedCrossRefGoogle Scholar
  10. 10.
    Ferguson J, Walker W (2006) Developing a VATS lobectomy programme: can VATS lobectomy be taught? Eur J Cardiothorac Surg 29:806–809PubMedCrossRefGoogle Scholar
  11. 11.
    Iwasaki A, Moriyama S, Shirakusa T (2008) New trainer for video-assisted thoracic surgery lobectomy. Thorac Cardiovasc Surg 56:32–36PubMedCrossRefGoogle Scholar
  12. 12.
    Iwasaki A, Okabayashi K, Shirakusa T (2003) A model to assist training in thoracoscopic surgery. Interact Cardiovasc Thorac Surg 2:697–701PubMedCrossRefGoogle Scholar
  13. 13.
    Hamilton EC, Scott DJ, Fleming JB, Rege RV, Laycock R, Bergen PC, Tesfay ST, Jones DB (2002) Comparison of video trainer and virtual reality training systems on acquisition of laparoscopic skills. Surg Endosc 16:406–411PubMedCrossRefGoogle Scholar
  14. 14.
    Usón J, Sánchez FM, Sánchez MA, Pérez FJ, Hashizume M (2007) Principios básicos. In: Usón J, Sánchez FM, Pascual S, Climent S (eds) Formación en Cirugía Laparoscópica Paso a Paso, 3rd edn. Centro de Cirugía de Mínima Invasión, Cáceres, pp 21–89Google Scholar
  15. 15.
    Addis A, Vanosi G, Manasse E, Mainetti M, Monaco A, Addis F (2007) An experimental sheep model used to develop an ablation procedure for chronic atrial fibrillation. Surg Endosc 21:1626–1630PubMedCrossRefGoogle Scholar
  16. 16.
    Cox JL, Ad N, Palazzo T, Fitzpatrick S, Suyderhoud JP, DeGroot KW, Pirovic EA, Lou HC, Duvall WZ, Kim YD (2000) Current status of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 12:15–19PubMedCrossRefGoogle Scholar
  17. 17.
    Schaff HV, Dearani JA, Daly RC, Orszulak TA, Danielson GK (2000) Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience. Semin Thorac Cardiovasc Surg 12:30–37PubMedGoogle Scholar
  18. 18.
    Damiano RJ, Voeller RK (2006) Surgical and minimally invasive ablation atrial fibrillation. Curr Treat Cardiovasc Med 8(5):371–376CrossRefGoogle Scholar
  19. 19.
    Manasse E, Infante M, Ghiselli S, Cariboni U, Alloisio M, Barbone A, Addis A, Gallotti R (2002) A video-assisted thoracoscopic technique to encircle the four pulmonary veins: a new surgical intervention for atrial fibrillation ablation. Heart Surg Forum 5:337–339PubMedGoogle Scholar
  20. 20.
    Williams MR, Knaut M, Berube D, Oz MC (2002) Application of microwave energy in cardiac tissue ablation: from in vitro analyses to clinical use. Ann Thorac Surg 74:1500–1505PubMedCrossRefGoogle Scholar
  21. 21.
    Cox JL (2004) The role of surgical intervention in the management of atrial fibrillation. Tex Heart Inst J 31:257–265PubMedGoogle Scholar
  22. 22.
    Szabo Z, Avery GJ, Sandor A, Litwin DE (2000) Suturing and knotting techniques for thoracoscopic cardiac surgery. Surg Clin North Am 80:1555–1574PubMedCrossRefGoogle Scholar
  23. 23.
    Nickel R, Schummer A, Wilkens H, Vollmerhaus B, Habermehl K-H (1981) The circulatory system, the skin, and the cutaneous organs of the domestic mammals. In: Nickel R, Seiferle E (eds) The anatomy of the domestic animals, vol 3. Verlag Paul Parey, Berlin, p 610Google Scholar
  24. 24.
    La Meir M, De Roy L, Blommaert D, Buche M (2007) Treatment of lone atrial fibrillation with a right thoracoscopic approach. Ann Thorac Surg 83:2244–2245PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Francisco M. Sánchez-Margallo
    • 1
  • Idoia Díaz-Güemes
    • 1
  • Francisco J. Pérez
    • 1
  • Miguel A. Sánchez
    • 1
  • Beatriz Loscertales
    • 1
  • Jesús Usón
    • 1
  1. 1.Department of Laparoscopic SurgeryMinimally Invasive Surgery Centre Jesús UsónCaceresSpain

Personalised recommendations