Elsevier

Thoracic Surgery Clinics

Volume 18, Issue 3, August 2008, Pages 235-247
Thoracic Surgery Clinics

The Variability of Practice in Minimally Invasive Thoracic Surgery for Pulmonary Resections

https://doi.org/10.1016/j.thorsurg.2008.06.002Get rights and content

Although minimally invasive thoracic surgery (MITS), under various denominations, is currently the accepted approach to the management of several thoracic diseases, its use for the treatment of lung cancer and infectious conditions of surgical interest is still debated, both from a philosophic and a technical point of view. The concept of minimally invasive pulmonary resections still provokes several controversies as to the terminology, the indications, and the techniques used by different surgeons. The issue of the variability of practice in this field of MITS is addressed through an analysis of the most recent literature and the results of an international survey that was originated and devised by the European Society of Thoracic Surgeons and supported by CTSnet.

Section snippets

The results of the European Society of Thoracic Surgeons Survey on the interpretation of minimally invasive thoracic surgery for major pulmonary resections

Several issues were addressed by the MITS survey, which was originally an ESTS project initially conducted on-line through the ESTS Web site (www.ests.org) as of November 2007. Afterward, the Survey was also made available in the Thoracic Portal of the Cardio-Thoracic Surgical Network (CTSnet; www.ctsnet.org) until April 2008. The questionnaire included 23 questions about MITS practice; an additional request for comments was also included as the twenty-fourth item on the survey.

After an on-line

Results

The answers given to the questionnaire were stratified by years of experience in the consultant position, with 10 years being the selected arbitrary cut point between the two groups. A second stratification was done according to the socioeconomic status of the country of practice of the responding surgeon, distinguishing between low- and middle-income and high-income countries as per the ESTS three-tier subscription fee format inspired by the criteria of the World Trade Organization (//www.ests.org

Summary

Thoracic surgeons participating in this survey seemed to have clearly indicated their perception of VATS major lung resections, in particular VATS lobectomy.

  • 1.

    The acronym VATS as a short form of “video-assisted thoracic surgery” was the preferred terminology.

  • 2.

    According to the respondents, the need or use of rib spreading served as the defining characteristic of “open” thoracic surgery.

  • 3.

    It was most commonly suggested that VATS lobectomy is performed by means of two or three port incisions with the

Acknowledgments

The authors thank Carol Blasberg and Tom Ferguson, MD, for their support with this project.

Cited by (97)

  • Conversion due to vascular injury during video-assisted thoracic surgery lobectomy: A multicentre retrospective analysis from the Italian video-assisted thoracic surgery group registry

    2019, European Journal of Surgical Oncology
    Citation Excerpt :

    The database receives only VATS lobectomies performed without the use of a rib spreader, monitor-based procedures without a direct intrathoracic view, with separated isolation/division of the hilar structures and lymph node staging (in the case of lung cancer resections) according to the European Society of Thoracic Surgeons (ESTS) guidelines [5]. Since VATS experienced surgeons frequently engaged challenging oncological cases with a higher chance for conversion [6] and mainly to review data coming from high-volume centres, only information from Units with >100 VATS lobectomies enrolled were retrospectively analysed. The arbitrary cut-off was first derived from the range of the learning curve for VATS lobectomy [7,8] and adjusted according to the ESTS minimal requirements for Thoracic Surgery units [9].

View all citing articles on Scopus
View full text