Consensus for thoracoscopic left upper lobectomy-essential components and targets for simulation
Bryan DS, Ferguson MK, Antonoff MB, Backhus LM, Birdas TJ, Blackmon SH, Boffa DJ, Chang AC, Chmielewski GW, Cooke DT, Donington JS, Gaissert HA, Hagen JA, Hofstetter WL, Kent MS, Kim KW, Krantz SB, Lin J, Martin LW, Meyerson SL, Mitchell JD, Molena D, Odell DD, Onaitis MW, Puri V, Putnam JB, Seder CW, Shrager JB, Soukiasian HJ, Stiles BM, Tong BC, Veeramachaneni NK. Consensus for Thoracoscopic Left Upper Lobectomy-Essential Components and Targets for Simulation. Ann Thorac Surg. 2020 Oct 27:S0003-4975(20)31739-2. doi: 10.1016/j.athoracsur.2020.06.152. Epub ahead of print. PMID: 33127408
BACKGROUND: Simulation-based training is a valuable component of cardiothoracic surgical education. Effective curriculum development requires consensus on procedural components and focused attention on specific learning objectives. Through use of a Delphi process, we established consensus on the steps of video-assisted thoracoscopic surgery (VATS) left upper lobectomy and identified targets for simulation.
METHODS: Experienced thoracic surgeons were randomly selected for participation. Surgeons voted and commented on the necessity of individual steps comprising VATS left upper lobectomy. Steps with greater than 80% of participants in agreement of their necessity were determined to have established "consensus." Participants voted on the physical or cognitive complexity of each, or both, and chose steps most amenable to focused simulation.
RESULTS: Thirty thoracic surgeons responded and joined in the voting process. Twenty operative steps were identified, with surgeons reaching consensus on the necessity of 19. Components deemed most difficult and amenable to simulation included those related to dissection and division of the bronchus, artery, and vein.
CONCLUSIONS: Through a Delphi process, surgeons with a variety of practice patterns can achieve consensus on the operative steps of left upper lobectomy and agreement on those most appropriate for simulation. This information can be implemented in the development of targeted simulation for VATS lobectomy.