Training in video-assisted thoracoscopic lobectomy.

Abstract

Video-assisted thoracoscopic surgery (VATS) is a minimally invasive alternative to open thoracotomy for major pulmonary resection and has been shown to have a number of benefits. VATS lobectomy is a safe and cost-effective treatment option (1,2). Compared to open thoracotomy, VATS lobectomy is associated with a reduction in post-operative pain, lower incidence of pneumonia and a shorter hospital stay, whilst maintaining equivalent oncological outcomes and long-term survival (3-9). However, despite the perceived benefits of VATS lobectomy, the majority of lobectomies are still performed as open procedures with relatively few centres offering VATS. This may be because the VATS approach is considered to be technically demanding with the potential for catastrophic haemorrhage in the hands of an inexperienced surgeon. Furthermore, the difficulty in arranging training in VATS lobectomy has meant that the technique has been disseminated slowly. We believe that senior trainees and consultants with ample experience of open lobectomy can be trained to perform VATS lobectomy by an experienced VATS surgeon without affecting patient outcomes. We here report the experience of a senior cardiothoracic surgical trainee undertaking a one-year fellowship with intensive exposure to VATS lobectomy under the supervision of a highly experienced consultant in a high-volume thoracic surgical unit.