Minimally invasive lung surgery possible as standard care

Only about 10 percent of lung cancer surgeries are performed with minimally invasive procedures, which result in less pain and reduced postoperative healing times. The surgeries are difficult and require a lot of additional training for surgeons; however, researchers recently created an effective plan for introducing the less-invasive techniques to surgical training programs.

Dr. Michael F. Reed and his colleagues from the University of Cincinnati provided a step-by-step plan for introducing thoracoscopic lobectomy — a minimally invasive surgery that involves several small incisions and doesn’t result in rib spreading — to two clinical institutions in Cincinnati. The researchers followed the results of their training program over a four-year period to compare the number of minimally invasive lobectomies performed before and after providing the training plan.

As presented in June at the Western Thoracic Surgical Association’s annual meeting in Santa Ana Pueblo, N.M., the training plan involved 1) establishing expertise in open lobectomy and video-assisted thoracoscopic surgery; 2) participating in a formal thoracoscopic lobectomy course; 3) being introduced to specific techniques used in thoracoscopic lobectomy; 4) proctoring of initial thoracoscopic lobectomies by thoracic surgical partners; and 5) teaching the technique to other thoracic surgeons and residents.

The researchers found that the number of lobectomies performed minimally invasively increased from 18 percent (9/50) prior to the training program to 84 percent (42/51) during the fourth year of the study. In addition, during the first year, new staff and trainees didn’t perform any of these lobectomies (0/9), but in the fourth year, they performed 76 percent (32/42) of them. A total of 202 thoracoscopic lobectomies were completed over the four years, increasing the number of these procedures performed by the university surgeons by 57 percent.

The investigators believe that their results indicate that thoracoscopic lobectomy can be effectively and safely added to academic surgical practices with a step-by-step training program.