Innovations to Improve Lung Isolation Training for Thoracic Anesthesia: A Narrative Review

Abstract

A double-lumen tube or bronchial blocker positioning using flexible bronchoscopy for lung isolation and one-lung ventilation requires specific technical competencies. Training to acquire and retain such skills remains a challenge in thoracic anesthesia. Recent technological and innovative developments in the field of simulation have opened up exciting new horizons and possibilities. In this narrative review, we examine the latest development of existing training modalities while investigating, in particular, the use of emergent techniques such as virtual reality bronchoscopy simulation, virtual airway endoscopy, or the preoperative 3D printing of airways. The goal of this article is, therefore, to summarize the role of existing and future applications of training models/simulators and virtual reality simulators for training flexible bronchoscopy and lung isolation for thoracic anesthesia.

Keywords: endoscopy; lung isolation; separation; simulation; thoracic anesthesia; training; virtual reality.

Figure 1

(a) Testing a bronchial blocker on a model. (b) Testing a double-lumen tube on a model. Reproduced with permission [26].

Figure 2

The Computer Airway Simulation System™.

Figure 3

CASS™ double-lumen tube module. (A) Starting position; (B) DLT in correct position; (C) DLT too deep; (D) DLT too superficial with cuff herniation.

Figure 4

VB showing the trachea bifurcation (left), and on the (right), a tracheoesophageal fistula (TOF) is illustrated in detail. T: trachea, E: esophagus, ∗: NGT, and blue arrows show the TOF fistula’s boundaries. Reproduced with permission [43].