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Thoracoscopic Lobectomy: Introduction of a New Technique into a Thoracic Surgery Training Program
M. F. Reed, M. W. Lucia, S. L. Starnes, W. H. Merrill, J. A. Howington. University of Cincinnati College of Medicine, Cincinnati, OH,
BACKGROUND: 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, and then teaching, of the technique.
METHODS: Thoracic surgical databases from two affiliated institutions were queried to identify all lobectomies during a four year period. Our model for introduction of thoracoscopic lobectomy was: 1) established expertise in open lobectomy and video-assisted thoracoscopic surgery; 2) participation in a formal thoracoscopic lobectomy course; 3) stepwise introduction of specific techniques utilized in thoracoscopic lobectomy into the operative approach; 4) proctoring of initial thoracoscopic lobectomies by thoracic surgical partners; and then 5) teaching the technique to other thoracic surgeons and residents.
RESULTS: Between July 1, 2002 and June 30, 2006 we performed 202 lobectomies: 97 open and 105 thoracoscopic. Mortality was 3.0% (6/202): 2.1% for open (2/97) and 3.8% for thoracoscopic (4/105). The conversion rate from thoracoscopic to open thoracotomy was 13% (14/105). When divided into quartiles, the percentage of lobectomies performed thoracoscopically increased from 18% (9/50) in the 1st quartile to 84% (42/51) in the 4th quartile (Figure A). With ongoing experience, the procedure was performed at higher frequency by new staff and trainees. Residents performed 0% (0/9) of thoracoscopic lobectomies in the 1st quartile, increasing to 54% (14/24) in the 3rd quartile. In the 4th quartile, residents and a new staff surgeon (proctored by colleagues) performed 76% (32/42) of thoracoscopic lobectomies (Figure B). 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 additional staff, as well as thoracic surgical residents, can thus be effectively accomplished.
 
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