Thoracoscopic lobectomy: Introduction of a new technique into a thoracic surgery training program

Objective Thoracoscopic lobectomy has been demonstrated to be safe and oncologically sound. However, few thoracic surgeons perform the operation. We hypothesized that use of a predetermined, stepwise plan for introduction of thoracoscopic lobectomy into a thoracic surgical training program would fac...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2008-08, Vol.136 (2), p.376-382
Main Authors: Reed, Michael F., MD, Lucia, Mark W., BS, Starnes, Sandra L., MD, Merrill, Walter H., MD, Howington, John A., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Cardiothoracic Surgery
Female
Humans
Internship and Residency
Lung Neoplasms - pathology
Lung Neoplasms - surgery
Male
Middle Aged
Pneumonectomy - adverse effects
Pneumonectomy - education
Pneumonectomy - methods
Thoracic Surgery - education
Thoracic Surgery, Video-Assisted - adverse effects
Thoracic Surgery, Video-Assisted - education
Thoracotomy
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective Thoracoscopic lobectomy has been demonstrated to be safe and oncologically sound. However, few thoracic surgeons perform the operation. We hypothesized that use of a predetermined, stepwise plan for introduction of thoracoscopic lobectomy into a thoracic surgical training program would facilitate safe learning of the technique. Methods Databases from 2 affiliated institutions were queried to identify all lobectomies during a 4-year period. Our model for introduction of thoracoscopic lobectomy was established expertise in open lobectomy and video-assisted thoracoscopic surgery, participation in a formal thoracoscopic lobectomy course, stepwise introduction of specific techniques used in thoracoscopic lobectomy into the operative approach, proctoring of initial thoracoscopic lobectomies by partners, and teaching of the technique to other thoracic surgeons and residents. Results We performed 202 lobectomies: 97 open and 105 thoracoscopic. Mortality was 3.0%. The conversion rate from thoracoscopic to open thoracotomy was 13%. When divided into quartiles, the percentage of lobectomies performed thoracoscopically increased from 18% in the first quartile to 82% in the fourth quartile. With ongoing experience, the procedure was performed at higher frequency by new staff and trainees. Residents performed 0% of thoracoscopic lobectomies in the first quartile, increasing to 54% in the third quartile. In the fourth quartile residents and a new staff surgeon performed 76% of thoracoscopic lobectomies. A resident was the operating surgeon for 37 thoracoscopic lobectomies. Conclusions Introduction of thoracoscopic lobectomy into an academic thoracic surgical practice can be achieved safely if a stepwise transition is invoked. Training of thoracic surgical residents and additional staff can thus be effectively accomplished.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2008.05.005