Troubleshooting video-assisted thoracic surgery lobectomy

Purpose. Surgeons converting their open lobectomy skills to video-assisted thoracic surgery (VATS) techniques have sought traditional technical courses, publications, and physician mentoring. While these are useful in teaching basic principles, it is more difficult to promulgate the numerous advanced techniques or technical "tricks" that deal with anatomical variations or pathologic changes in the lung tissue. Description. Engineers have simplified the process of rolling out complex technology by using troubleshooting guides. Accordingly, helpful video-assisted lobectomy maneuvers have been categorized according to the specific problems occasionally encountered at different points in the operation. Evaluation. These maneuvers were compiled and reviewed by a panel of thoracic surgeons experienced in video-assisted lobectomies and have been active in teaching and mentoring of thoracic surgeons, residents and fellows. The techniques described have been used successfully by the authors to overcome exposure and instrumentation limitations, to achieve the outcomes reported in their series, and to guide trainees. Conclusions. Troubleshooting guides offer an organized means for surgeons to improve the parts of the video-assisted lobectomy procedure that they find tedious or challenging. © 2005 by The Society of Thoracic Surgeons.