General Thoracic

On day three of the STS 2025 Annual Meeting, Dr. Jeremiah Hayanga, professor of thoracic surgery, Department of Cardiovascular and Thoracic Surgery, West Virginia University, will present a session titled, Endobronchial Valve Therapy (EVT) versus Lung Volume Reduction Survey (LVRS) in the US. In this presentation, Dr. Hayanga and his research team will share new, risk-adjusted study results that provide fresh insights into treatments for severe emphysema.

Recent findings suggest that as surgical practices evolve, LVRS may offer better long-term results for patients with advanced emphysema compared to EBV therapy. Although EBV patients had shorter hospital stays, lower charges, and fewer pre-existing conditions, the study revealed they experienced more complications and a higher risk of death over time than those who underwent LVRS.

To be held Sunday, Jan. 25, at 8 a.m. during the larger “Modernized Solutions for Lung Failure, From Bench to Bedside” session, Dr. Hayanga will also discuss the limitations of lung transplantation as a solution for severe emphysema due to the shortage of donor organs. 

“Surgical lung volume reduction, explored in the late 1990s, did not gain widespread acceptance due to its associated risks and the small pool of patients who were thought to benefit,” says Dr. Hayanga. “However, with advancements in surgical techniques and risk management, LVRS has seen improved outcomes, offering hope for patients who are not candidates for lung transplants.”

The rapid advancement of robotic technology has revolutionized the field of thoracic surgery. At the same time, the technological leap has highlighted a pressing need to bridge the educational gap in the training of thoracic surgery trainees. To address this issue, the Society of Thoracic Surgeons has developed an expert consensus document outlining a framework for a standardized national robotic curriculum.

A recent paper published in The Annals of Thoracic Surgery, authored by the Task Force on Robotic Thoracic Surgery and the Workforce on E-learning and Educational Innovation, has provided expert consensus statements for thoracic surgery training programs. This paper was created following an extensive literature review and expert consensus achieved through a modified Delphi process. It outlines expectations for programs, essential training components, as well as assessment and feedback methods.

Program Expectations

• Standardization: The consensus document advocates for standardized robotic thoracic curricula across all Accreditation Council for Graduate Medical Education-accredited programs.
• Dual Console Training: Trainees should have ample opportunity to practice on dual consoles during most cases to actively participate in the surgical process.
• Bedside Assistance: The presence of a trained bedside assistant during teaching cases is strongly recommended.

Components of Training

• Theoretical & Practical: The curriculum must integrate theoretical and practical learning.
• Pre-Console Training: Online modules on robotic components and hands-on training are mandatory before console surgery.
• VR Simulation: Proficiency in digital/virtual reality simulation modules is a prerequisite for console surgery.
• Wet Lab Training: Mandatory participation in at least one wet lab per year.
• Emergency Conversion: Mandatory to perform with the trainees or OR team at least once a year.

Assessment and Feedback

• Skill Assessment: Utilize objective tools like Global Evaluative Assessment of Robotic Skills to assess technical competency.
• EPA Development: Develop Entrusted Professional Activity for pulmonary resection.
• Performance Review: Regular video review and analysis of robotic performances provide valuable feedback.

By implementing the recommendations outlined in this expert consensus document, thoracic surgery training programs can ensure that trainees are well-prepared to perform complex robotic procedures and contribute to the advancement of thoracic surgery.

"Robotic surgery is rapidly evolving, and it's crucial that our training programs keep pace,” said Samuel Kim, MD, Northwestern Medicine, who chaired the task force that produced the document. "To ensure a skilled workforce capable of meeting the demands of modern thoracic surgery, we must prioritize a standardized curriculum that enhances resident education and bridges any existing educational disparities across training programs. By fostering a comprehensive learning environment that emphasizes both refined technical skills and sound clinical judgment, we can effectively train the next generation of surgical leaders."

Read the Annals article here.