Learning thoracoscopic lobectomy.
OBJECTIVE
Thoracoscopic (video-assisted thoracoscopic surgery (VATS)) lobectomy is a safe and effective method for treating early-stage lung cancer. Despite this, it is still not widely practised, which could be due to a shallow learning curve. We have evaluated the surgical outcome in a training programme at an institution with an established VATS lobectomy programme. We present the surgical data and outcome of the first 50 intended VATS lobectomies performed by a consultant in training as the primary surgeon.


METHODS
Data were obtained from a prospectively registered surgical database consisting of 262 consecutively intended VATS lobectomies. A single consultant performed 212 intended VATS lobectomies. His first 50 intended VATS lobectomies were excluded, as they were considered to be his learning curve, leaving 162 intended VATS lobectomies, of which 12 were converted to open lobectomy, performed from January 2005 to April 2008. Fifty intended VATS lobectomies were performed by a consultant in a training programme for VATS lobectomies, of which three were converted to open lobectomy from April 2007 to April 2008. The training consultant was experienced in open thoracic surgery and had performed more than 200 minor VATS procedures prior to the training programme. The surgical data and outcome between the 47 VATS lobectomies were compared with the 150 VATS lobectomies performed by the experienced consultant using statistical analysis.


RESULTS
There were significantly better results for the training consultant regarding prolonged air leak, chest tube duration and length of stay, which probably reflects the careful selection of the patients favouring the training consultant. The operation time was significant longer for the consultant in training (p<0.0001).


CONCLUSIONS
With careful selection of patients, VATS lobectomy can be taught safely in a surgical institution experienced in VATS lobectomies. Using statistical analysis, the surgical outcome for the training consultant was acceptable in comparison to the outcome of the experienced consultant. The consultant in training did spend more time in the operating theatre (p<0.0001) and we recommend taking that into account when planning future training programmes in VATS lobectomy.
Petersen
René Horsleben
RH
Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark. rene.petersen@rh.regionh.dk
Hansen
Henrik Jessen
HJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence; D003718:Denmark; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D059032:Learning Curve; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000193:education* / Q000379:methods / Q000592:standards; D015397:Program Evaluation; D020775:Thoracic Surgery, Video-Assisted / Q000193:education* / Q000379:methods / Q000592:standards; D016896:Treatment Outcome; D055815:Young Adult