title: Thoracoscopic lobectomy: introduction of a new technique into a thoracic surgery training program.
abstract: 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.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Cincinnati VA Medical Center, Cincinnati, OH 45267-0558, USA. michael.reed@uc.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Reed
authors.forename: Mark W
authors.initials: MW
authors.lastname: Lucia
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Starnes
authors.forename: Walter H
authors.initials: WH
authors.lastname: Merrill
authors.forename: John A
authors.initials: JA
authors.lastname: Howington
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000193:education* / Q000379:methods; D013903:Thoracic Surgery / Q000193:education*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000193:education*; D013908:Thoracotomy