VATS Lobectomy Training and Instruction

For purposes of this survey, participants were asked to assume that they consulted on an otherwise healthy middle aged patient who had a peripheral 2 cm right upper lobe adenocarcinoma, clinical stage Ia, not amenable to wedge resection or segmentectomy. There were no contraindications to lobectomy.

The vast majority of respondents indicated that they would perform a VATS lobectomy rather than an open operation.  This indicates that the respondents were surgeons who were already performing VATS lobectomy.  Results of subsequent questions should be interpreted with this fact in mind.

Almost one-third of respondents received training in VATS lobectomy during their formal education.  Interestingly, over half of the respondents learned VATS lobectomy on their own, through participation in a short, focused course, or while observing another practitioner.

The confidence with which surgeons approach VATS lobectomy varies considerably.  Although over 50% felt confident or very confident, about 40% felt their comfort level was moderate or poor.  Over 80% of surgeons routinely cautioned their patients about the possible need to convert to an open operation.

About half of the respondents teach residents how to perform these operations.  There was a varied opinion as to how many cases were felt necessary to achieve competence in the procedure, with over two-thirds stating that 25 to 50 or more cases were necessary.  About 20% of participants felt that 10 cases were sufficient to achieve adequate skill.  Over 60% of respondents felt that a short course in VATS lobectomy by itself was not sufficient to permit the development of competency in this technique.

1. Would you normally perform a VATS lobectomy for this patient?
	answered question		201
	skipped question		0
		Response Percent	Response Count
Yes		86.6%	174
No		13.4%	27

2. How did you learn to perform VATS lobectomy?
	answered question		198
	skipped question		3
		Response Percent	Response Count
During a formal (accredited) thoracic residency/fellowship.		29.8%	59
During a non-accredited clinical fellowship lasting a year or more.		6.1%	12
At a short, focused course for VATS lobectomy.		17.7%	35
By informal observation at a busy clinical center.		14.1%	28
On your own using videos, trial and error.		23.2%	46
Other		9.1%	18

3. What is your comfort level for performing VATS lobectomy?
	answered question		198
	skipped question		3
		Response Percent	Response Count
Very high		27.8%	55
High		30.8%	61
Moderate		31.3%	62
Low		10.1%	20

4. Do you caution patients about the possible need for conversion to an open approach?
	answered question		198
	skipped question		3
		Response Percent	Response Count
No, the likelihood of this in my practice is too low to warrant this discussion in most instances.		3.5%	7
Yes, but only when I believe the risk is increased.		14.6%	29
Yes, routinely.		81.8%	162

5. Do you teach residents or fellows how to perform VATS lobectomy?
	answered question		198
	skipped question		3
		Response Percent	Response Count
Yes		51.0%	101
No		49.0%	97

6. How many VATS lobectomies do you think are necessary to perform to achieve adequate skill in this procedure?
	answered question		197
	skipped question		4
		Response Percent	Response Count
10		21.3%	42
25		41.6%	82
50		30.5%	60
75 or more		6.6%	13

7. Do you believe a short course focused on learning VATS lobectomy is sufficient to permit safe clinical performance of this procedure?
	answered question		198
	skipped question		3
		Response Percent	Response Count
Yes		38.4%	76
No		61.6%	122

8. In what region is your surgical practice based?
	answered question		198
	skipped question		3
		Response Percent	Response Count
North America		52.5%	104
Europe		18.7%	37
South America		8.1%	16
Asia		19.2%	38
Africa		1.5%	3