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Updated: Oct 15, 2025

Subcostal Specimen Removal in Completely Portal Robotic Lobectomy
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Consensus for Thoracoscopic Lower Lobectomy: Essential Components and Targets for Simulation.

Philip A Erwin1, Andy C Lee1, Usman Ahmad2

  • 1Department of Surgery, University of Chicago, Chicago, Illinois.

The Annals of Thoracic Surgery
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Summary
This summary is machine-generated.

This study identified 18 essential steps for video-assisted thoracic surgery (VATS) lower lobectomy using a Delphi process. Key steps for simulation training include pulmonary artery branches, lower lobe bronchus, and inferior pulmonary vein dissection.

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Area of Science:

  • Thoracic Surgery
  • Minimally Invasive Surgery
  • Surgical Education

Background:

  • Video-assisted thoracic surgery (VATS) offers benefits over open procedures for pulmonary lobectomy but lacks universal adoption.
  • Barriers to VATS adoption may stem from a lack of standardized essential components and effective training methods.
  • This study addresses the need for standardized VATS lobectomy components and identifies key areas for simulation training.

Purpose of the Study:

  • To establish the essential components of video-assisted thoracic surgery for lower lobectomy.
  • To identify specific surgical steps most suitable for simulation-based training to enhance VATS adoption.

Main Methods:

  • A modified Delphi process involving experienced thoracic surgeons was employed to reach consensus on essential VATS lower lobectomy components.
  • Surgeons anonymously provided feedback over three rounds to identify and agree upon critical surgical steps.
  • Essential components were rated for cognitive and technical difficulty, and suitability for simulation training was assessed.

Main Results:

  • Eighteen essential components for VATS lower lobectomy were identified through the Delphi process.
  • The most challenging steps identified were the isolation and division of pulmonary artery branches, lower lobe bronchus, and lymphovascular dissection.
  • Isolation and division of pulmonary artery branches, lower lobe bronchus, and inferior pulmonary vein were deemed most appropriate for simulation.

Conclusions:

  • A consensus was reached on the essential components for performing VATS lower lobectomy.
  • Three specific components were identified as highly suitable for simulation-based training.
  • These findings provide valuable insights for developing targeted simulation programs to improve VATS proficiency and adoption.