New standardized five-zone lobectomy with structured assessment in robotic surgery: the French lobectomy

The use of the robotic approach is rapidly increasing in thoracic surgery worldwide. Mastering this new technique is challenging and teaching robotic surgery is difficult. Nevertheless, to date, no academic certified training program including a standardized approach is available for robotic lobectomy and no objective assessment scale has been proposed. Here we describe new objective criteria for robotic lobectomy including a standardised surgical technique and an objective structured assessment scale to improve educational support for thoracic surgeons. The technique, referred to as the French lobectomy, is a standardized technique, and is based on five exposure and dissection zones. Each zone contains a number of dissection steps, which all together form a complete lobectomy. The technique can be applied to all lobectomies (and segmentectomies) for both the left and right side. In parallel, an objective structured assessment scale is designed to evaluate the performance of trainee surgeons who use the technique. This scale is based on five items with a minimum score of 5 points and a maximum score of 25 points. A conduct to follow based on the score obtained is proposed. This systematic and standardized robotic approach to lobectomies and its assessment scale, may allow surgeons and trainees to improve their technical skills and efficiency.