Time Taken for Pulmonary Vein Management by Residents Performing Video-Assisted Thoracoscopic Surgical Lobectomy for Malignant Thoracic Diseases

Residents with limited experience of thoracic surgery have difficulty performing video-assisted thoracoscopic surgery (VATS) lobectomy. However, they can learn early in a stepwise training method to safely manage the pulmonary veins (PVs), which are relatively strong vessels. In this study, we investigated whether the time required to manage the PVs could serve as an indicator of technical skill acquisition in VATS lobectomy. To evaluate the acquisition of residents’ technical skills, we retrospectively assessed the PV management time of 5 residents at our institution who had performed more than 15 VATS lobectomies over an 8-year period (2012–2019). Their PV management time was determined from surgical video. We analyzed whether PV management time was affected by patient characteristics, operative factors, and experience of lobectomy. The 5 residents performed a total of 103 VATS lobectomies during the study period. Median PV management time was 9.6 min. The most frequently resected lobe was the right upper lobe (56.3%). Median PV management time for right middle lobe was 5.2 min, which was shorter than that for other lobes. We categorized the lobectomies according to whether PV management time was ≤10 min or > 10 min. Univariate analysis identified that shorter PV management time (≤10 min) was significantly associated with more right middle lobectomies performed (7.3% vs 0%, p = 0.02) and more lobectomies performed (14 vs 8, p = 0.01). Longer PV management time (>10 min) was significantly associated with lower lobectomies performed (18% vs 35%, p < 0.05). Multivariate analysis confirmed the association of shorter PV management time with right middle lobectomy (p = 0.01) and more lobectomies performed (p < 0.01). The residents may embark on more difficult steps of VATS lobectomy once pulmonary vein management is mastered.