Consensus for Thoracoscopic Lower Lobectomy: Essential Components and Targets for Simulation

Philip A. Erwin, Andy C. Lee, Usman Ahmad, Mara Antonoff, Andrew Arndt, Leah Backhus, Mark Berry, Thomas Birdas, Stephen D. Cassivi, Andrew C. Chang, David T. Cooke, Traves Crabtree, Malcolm DeCamp, Jessica Donington, Felix Fernandez, Seth Force, Henning Gaissert, Wayne Hofstetter, James Huang, Michael KentAnthony W. Kim, Jules Lin, Linda W. Martin, Shari Meyerson, John D. Mitchell, Daniela Molena, David Odell, Mark Onaitis, Varun Puri, Joe B. Putnam, Rishindra Reddy, Paul Schipper, Christopher W. Seder, Joseph Shrager, Betty Tong, Nirmal Veeramachaneni, Thomas Watson, Richard Whyte, Mark K. Ferguson

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Background: Despite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation and determining which steps are most useful for simulation training. Methods: After randomly selecting experienced thoracic surgeons to participate, an initial list of components to a lower lobectomy was distributed. Feedback was provided by the participants, and modifications were made based on anonymous responses in a Delphi process. Components were declared essential once at least 80% of participants came to an agreement. The steps were then rated based on cognitive and technical difficulty followed by listing the components most appropriate for simulation. Results: After 3 rounds of voting 18 components were identified as essential to performance of a video-assisted thoracic surgery for lower lobectomy. The components deemed the most difficult were isolation and division of the basilar and superior segmental branches of the pulmonary artery, isolation and division of the lower lobe bronchus, and dissection of lymphovascular tissue to expose the target bronchus. The steps determined to be most amenable for simulation were isolation and division of the branches of the pulmonary artery, the lower lobe bronchus, and the inferior pulmonary vein. Conclusions: Using a Delphi process a list of essential components for a video-assisted thoracic surgery for lower lobectomy was established. Furthermore 3 components were identified as most appropriate for simulation-based training, providing insights for future simulation development.

    Original languageEnglish (US)
    JournalAnnals of Thoracic Surgery
    DOIs
    StateAccepted/In press - 2022

    ASJC Scopus subject areas

    • Surgery
    • Pulmonary and Respiratory Medicine
    • Cardiology and Cardiovascular Medicine

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