Objective

Video-Assisted Thoracoscopic (VATS) lobectomy has been growing in popularity and has been advocated as standard care for early non-small cell lung cancer. However, there is a lack of consensus among thoracic surgeons on how this complex procedure should be implemented into a training program. A steep learning curve and potential impact on patient safety have been particular concerns. We analyse the impact on VATS lobectomy training on conversion rates, theatre time and patient outcomes.

Methods

This was a retrospective analysis of data collected prospectively on our thoracic database. Between April 2014 and October 2015, 417 major resections (lobectomy, bilobectomy and pneumonectomy) for lung cancer were performed. Multivariate regression analysis (using IBM SPSS 22) was used to determine factors which impacted on operative outcomes (operating time and conversion from VATS to Open) and post-operative outcomes including mortality, length of hospital stay and non-fatal complications.

Results

VATS was employed in 312 cases whist 105 were performed with an open conventional technique. In VATS, 60.2% (188/312) were performed by consultants and 39.8% (124/312) by trainees. In VATS, the differences in conversion rate (3.3% vs 5.9%), operating time (153.01 mins vs 151.08 mins), post-operative complication rate and resection margin were not statistically significant between trainee and consultant respectively (p>0.05) after adjusting for tumour stage, performance status and co-morbidities.

Conclusion

The difficulties with VATS lobectomy training have been extensively debated. They include the requirements for adequately large case volume, experienced supervision, dedicated teams, steep learning curve and concerns about life-threatening intra-operative complications. Our results demonstrate that VATS lobectomy training in a high volume unit for non-small cell lung cancer does not have an adverse impact on conversion rates, theatre time and post-operative complications.