Pediatric Thoracoscopic Training in an Experimental Pleural Empyema Rabbit Model

Abstract

Thoracoscopy has proved to be effective in the treatment of stage 2 (fibrinopurulent) empyema, but this technique requires different abilities from those needed in open surgery. The aim of this study is to evaluate the usefulness of an experimental empyema in rabbits as a thoracoscopic training model. Twenty New Zealand rabbits were anesthetized with acepromazine and ketamine. A Veress needle was introduced into the pleural space, and a turpentine and saline solution were injected. Twenty-four hours later, 1016 colony-forming units of Escherichia coli and 1 g of agar in 1 mL of saline solution were injected. The rabbits were operated on 96 hours after bacterial injection by 30 pediatric surgeons attending a hands-on pediatric laparoscopic course. The contralateral lung was selectively intubated and three ports were placed to perform an empyema debridement. The surgeons evaluated the model using subjective criteria from an evaluation form. One animal died (5%) and 2 (10%) did not form empyema. The other 17 rabbits (85%) presented with a fibrinopurulent empyema. All usual surgical steps could be performed. As regards the surgeons' opinion of the model, 23 (76.7%) considered it very good while 7 (23.3%) thought it was good. Twenty-three (76.7%) answered that the empyema stage was correct for thoracoscopic treatment. As reflected by our experience and the survey completed by the 30 pediatric surgeons, this empyema model in rabbits is very useful for thoracoscopic training.