Consensus for thoracoscopic lower lobectomy: Essential components and targets for simulation Journal Article


Authors: Erwin, P. A.; Lee, A. C.; Ahmad, U.; Antonoff, M.; Arndt, A.; Backhus, L.; Berry, M.; Birdas, T.; Cassivi, S. D.; Chang, A. C.; Cooke, D. T.; Crabtree, T.; DeCamp, M.; Donington, J.; Fernandez, F.; Force, S.; Gaissert, H.; Hofstetter, W.; Huang, J.; Kent, M.; Kim, A. W.; Lin, J.; Martin, L. W.; Meyerson, S.; Mitchell, J. D.; Molena, D.; Odell, D.; Onaitis, M.; Puri, V.; Putnam, J. B.; Reddy, R.; Schipper, P.; Seder, C. W.; Shrager, J.; Tong, B.; Veeramachaneni, N.; Watson, T.; Whyte, R.; Ferguson, M. K.
Article Title: Consensus for thoracoscopic lower lobectomy: Essential components and targets for simulation
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. © 2022 The Society of Thoracic Surgeons
Keywords: adult; controlled study; consensus; dissection; simulation; delphi study; bronchus; lobectomy; video assisted thoracoscopic surgery; human experiment; pulmonary artery; pulmonary vein; human; male; female; article; thoracic surgeon; simulation training
Journal Title: Annals of Thoracic Surgery
Volume: 114
Issue: 5
ISSN: 0003-4975
Publisher: Elsevier Science, Inc.  
Date Published: 2022-11-01
Start Page: 1895
End Page: 1901
Language: English
DOI: 10.1016/j.athoracsur.2021.09.033
PUBMED: 34688617
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 1 November 2022 -- Source: Scopus
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  1. James Huang
    214 Huang
  2. Daniela   Molena
    270 Molena