Learning Curve of a Young Surgeon's Video-assisted Thoracic Surgery Lobectomy during His First Year Experience in Newly Established Institution

Abstract

BackgroundThe purpose of this paper is to present a guideline for beginning video-assisted thoracic surgery (VATS) lobectomy to junior surgeons, and to review the first year experience of a new surgeon performing VATS lobectomies who had not performed a VATS lobectomy unassisted during his training period.Materials and MethodsA young surgeon opened a division of general thoracic surgery at a medical institution. The surgeon had performed about 100 lobectomies via conventional thoracotomy during his training period, but had never performed a VATS lobectomy unassisted while under the supervision of an expert. After opening the division of general thoracic surgery, the surgeon performed a total of 38 pulmonary lobectomies for various pulmonary diseases from March 2009 to February 2010. All data were collected retrospectively.ResultsThere were 14 lobectomies via thoracotomy, 14 VATS lobectomies, and 10 cases of attempted VATS lobectomies that were converted to open thoracotomies. The number of VATS lobectomies increased from the second quarter (n=0) to the third quarter (n=5). The lobectomies that were converted from VATS into thoracotomies decreased from the second quarter (n=5) to the third quarter (n=1) (p=0.002).ConclusionIt can take 6 months for young surgeons without experience in VATS lobectomy in their training period to be able to reliably perform a VATS lobectomy.

Video-assisted thoracic bronchial sleeve lobectomy with bronchoplasty for treatment of lung cancer confined to a single lung lobe: a case series of Chinese patients

“…While operator experience is a key factor to surgical success of VATS and VABSL, guidelines for junior surgeons (<100 surgeries performed) have been recently proposed in Korea and indicate that the VATS lobectomy technique can be dramatically improved over the course of only 6 months. Thereafter, junior surgeons reported similar conversions to open surgery and outcomes as experienced surgeons [ 22 ]. Similarly, European VATS training programs have been designed, and showed that prolonged air leak, chest tube duration, operation time and length of stay were reduced by training, most likely due to superior patient selection by trained operators [ 23 , 24 ].…”

National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: the Italian VATS register evaluation

“…Skill acquisition or competence is the benchmark by which physicians are permitted to perform procedures safely and independently via an elaborate operation entail of a sufficient number of processes. For minimally invasive lobectomy, this appears to require a minimum of twenty to thirty cases, with estimates as high as fifty operations (10)(11)(12). Determining the significant case numbers to attain procedural skills is important but should not be strictly considered; in other words, newly trained surgeons should Background: The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold.…”

Is the learning curve for video-assisted thoracoscopic lobectomy affected by prior experience in open lobectomy?: Table 1.

“…In the field of abdominal surgery and especially in urology, where robotic prostatectomy has become the gold standard, experienced open surgeons can safely incorporate robotic procedures into practice and achieve outcomes comparable to fellowship-trained robotic surgeons quickly [2]. The advantage of using the robotic 3D camera in coordination with the instruments is that the vision is directed to the target tissue, bringing the instruments to address the target lesion from a straight perspective and obtaining similar angle of view as for open surgery [3] And here is where controversy begins.…”