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

Abstract

BACKGROUND\nDespite demonstration of its clear benefits relative to open approaches, a video-assisted thoracic surgery (VATS) technique for pulmonary lobectomy has not been universally adopted. This study aims to overcome potential barriers by establishing the essential components of the operation as well as determining which steps would be most useful for simulation training.\n\n\nMETHODS\nAfter 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 upon cognitive and technical difficulty, followed by listing the components most appropriate for simulation.\n\n\nRESULTS\nAfter three rounds of voting, 18 components were identified as essential to performance of a VATS lower lobectomy. The components deemed the most difficult included isolation and division of the basilar and superior segmental branches of the pulmonary artery, isolation and division of the lower lobe bronchus, and the dissection of lymphovascular tissue to expose the target bronchus. The steps determined to be most amenable for simulation included isolation and division of the branches of the pulmonary artery, the lower lobe bronchus, and the inferior pulmonary vein.\n\n\nCONCLUSIONS\nUsing a Delphi process, a list of essential components for a VATS lower lobectomy was established. Furthermore, three components were identified as most appropriate for simulation-based training, providing insights for future simulation development.