Il corso di specializzazione in chirurgia cardio-toracica (residency) negli stati uniti è, come sappiamo noi chirurghi europei ed italiani, probabilmente il massimo oggi disponibile per la formazione di un chirurgo toracico, tuttavia solamente il 50% circa dei neospecialisti americani dichiara di avere adeguate capacità nella chirurgia mininvasiva, capacità tali da consentire di affrontare delle lobectomie polmonari video-assistite. Il dato è interessante perchè andrebbe paragonato a quello delle scuole di specializzazione in chirurgia toracica italiane: quandi specializzandi avranno mai eseguito una sola lobectomia polmonare video-assistita nel loro iter formativo??
Self-perceived video-assisted thoracic surgery lobectomy proficiency by recent graduates of North American thoracic residencies.
Source
Department of Thoracic Surgery, Yale University School of Medicine, Smilow Cancer Hospital, New Haven, CT, USA.
Abstract
Minimally invasive surgical techniques offer several advantages over traditional open procedures, yet the pathway to minimally invasive proficiency can be difficult to navigate. As a part of an effort of the Joint Council of Thoracic Surgical Education to increase access to this skill set in the general thoracic community, recent graduates of thoracic residencies were surveyed to determine the self-reported achievement of video-assisted thoracic surgery (VATS) lobectomy proficiency and the merits of various educational opportunities. The objective of this study was to estimate the comfort level of recent graduates with the minimally invasive approach, as this demographic not only reflects the current status of training, but represents the future of the specialty. Surgeons graduating North American thoracic residencies between 2006 and 2008 identifying themselves as practitioners of general thoracic surgery were surveyed. A total of 271 surgeons completed training between 2006 and 2008 and indicated general thoracic to be a part of their practice (84 dedicated thoracic and 187 mixed). One hundred and forty-six surgeons completed the survey (54%) including 74 of 84 (88%) dedicated thoracic surgeons. Overall, 58% of recent graduates who perform general thoracic procedures consider themselves proficient in VATS lobectomies (86% of dedicated thoracic surgeons and 28% of surgeons with a mixed practice, P < 0.0001). Of surgeons considering themselves to be proficient at VATS lobectomies, 66% felt thoracic residency was critical or very important to achieving proficiency. Fellowships after completing board residency, animal labs, and follow-up VATS courses put on by experts were much less consistently beneficial. The vast majority of the 25 dedicated general thoracic surgeons who graduate each year consider themselves proficient in VATS lobectomies, largely due to training in their thoracic residencies. On the other hand, the minority of surgeons performing general thoracic procedures as a part of a mixed practice consider themselves proficient in VATS lobectomies. Further study is warranted to enhance the VATS lobectomy experience of mixed practice surgeons particularly during their thoracic residencies.
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