Training with Video-Assisted Thoracic Surgery

We read the article written by Bille and colleagues with a great interest.[1] For thoracic surgery residents trained in our clinic, we started the training with open surgery before VATS. In open surgery, the residents learnt how to explore the thoracic cavity, release the inferior pulmonary ligament, and find the pulmonary lobar artery, vein, and inferior pulmonary trunk and release them with wright-angled clamp for peripheral tumors in lobectomy or segmentectomy. We showed them some key points to dissect the mediastinum. They include that finding the nos. 4 and 10 lymph nodes after determining azygos vein, trachea, and vena cava superior and opening the mediastinal pleura; especially for left hemithorax, dissection of aortopulmonary window to find nos. 5 and 6 lymph nodes and also palpation and recognizing the tumor. All residents agreed that the exposure of VATS is much better and it was less exciting but safer. Particularly in mediastinal lymph node dissection, the exposure was excellent. In VATS resections, it provided the dissection of bronchovascular branches with a high-definition display without using costal separators. Using the staple proved to be safe and provided confidence.[2] We are of the opinion that a good VATS surgeon must be also good in open surgery, because all operations could be changed to open surgery.

• References

• 1 Billè A, Okiror L, Harrison-Phipps K, Routledge T. Does Previous Surgical Training Impact the Learning Curve in Video-Assisted Thoracic Surgery Lobectomy for Trainees?. Thorac Cardiovasc Surg 2016; 64 (04) 343-347
• 2 Oncel M, Sunam GS, Yildiran H. Assistant Training Using Videothoracoscopy. Ann Thorac Surg 2016; 101 (04) 1636