University of Cincinnati surgeons say minimally invasive lung surgery should be standard care

Cincinnati 29 June 2007Major United States academic medical centres can successfully - and safely - integrate minimally invasive lung surgery into their training programmes with a standardized, step-by-step plan, according to University of Cincinnati (UC) thoracic surgeons. It's estimated that only about 10 percent of all lung cancer operations nationwide are done with minimally invasive techniques, but more than half the patients who need the surgery would qualify for the less invasive procedure, which results in faster recovery time and less pain for patients.

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The minimally invasive lung surgery, known as a thoracoscopic lobectomy, is done through several small incisions, versus a major chest incision, and requires no rib spreading. The University of Cincinnati is one of only a handful of academic medical centres actively training surgeons to perform the procedure.

"Thoracoscopic lobectomy should be considered the standard of care for patients with early-stage lung cancers", stated Michael Reed, MD, assistant professor of surgery at UC and minimally invasive thoracic surgeon at the University Hospital. "But few surgeons offer the procedure because it's difficult and requires a lot of additional training."

"We've shown that with a predetermined, step-by-step plan - guided by highly experienced minimally invasive thoracic surgeons - thoracoscopic lobectomy can be integrated safely into thoracic surgical training programmes", Dr. Reed added.

Using this strategy, the UC surgeons have increased the number of minimally invasive lobectomies they perform by about 57 percent over four years. Dr. Reed estimates 75 percent of all lobectomies at the University Hospital are now done using the minimally invasive approach. Prior to implementation of the training programme, only about 18 percent of lobectomies were performed minimally invasively.

Dr. Reed presented the findings on June 29, at the Western Thoracic Surgical Association's annual meeting in Santa Ana Pueblo, New Mexico. Dr. Reed and his UC colleague, Sandra Starnes, MD, conducted a four-year review of thoracic surgical cases at the University Hospital and the Cincinnati Department of Veterans Affairs Medical Center to compare minimally invasive lobectomies performed by their team before and after implementation of a formal training programme.

The Cincinnati team has trained two cardiothoracic surgery fellows and more than a dozen community thoracic surgeons to perform minimally invasive lung surgery. "The key to implementing this programme into our practice was having a dedicated team of extensively trained thoracic surgeons with expertise in both open and minimally invasive, video-guided techniques", added Dr. Starnes. "This isn't a procedure you can perform confidently after just a few cases - mentorship and experience are key."

Collaborators in this study include Mark Lucia; Sandra Starnes, MD; Walter Merrill, MD; and John Howington, MD, who completed this work at the University of Cincinnati and is now in private practice at Evanston Hospital in Illinois.


Leslie Versweyveld

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