Editorial
Implementing a VATS Lobectomy Program in Spain. The Wet Lab, a Necessary Tool
¿Cómo implementar un programa de lobectomía VATS en España? El laboratorio experimental (Wet Lab) es una herramienta necesaria
Marcelo Jiménez López
, Nuria María Novoa Valentín
Corresponding author
Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Centro de Simulación y Experimentación Quirúrgica, Universidad de Salamanca, Salamanca, Spain
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The Wet Lab, a Necessary Tool" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "579" "paginaFinal" => "580" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marcelo Jiménez López, Nuria María Novoa Valentín" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Marcelo" "apellidos" => "Jiménez López" "email" => array:1 [ 0 => "mfjl@usal.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Nuria María" "apellidos" => "Novoa Valentín" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Centro de Simulación y Experimentación Quirúrgica, Universidad de Salamanca, Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Cómo implementar un programa de lobectomía VATS en España? El laboratorio experimental (Wet Lab) es una herramienta necesaria" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Video-assisted anatomical lung resections should become standard treatment in most patients with early-stage lung cancer. No studies have yet produced quality evidence, but a large number of publications have shown that video-assisted thoracic surgery (VATS) has a number of advantages over thoracotomy,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> and it seems reasonable that patients should be offered this minimally invasive approach.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to the 2015 European Society of Thoracic Surgeons database report, only 21% of lung resections performed in Europe used this approach, while in Spain the percentage was as low as 15%.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">To address this inconsistency, we need to develop continuous and complementary training strategies in an experimental setting to provide the training that will ensure that these procedures are being safely performed in our patients. We believe that these methodologies should be shared, as this approach has enabled our group to prepare all the surgeons of our unit to perform this surgery safely.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The implementation of new surgical techniques, such as video-assisted anatomical lung resections, requires continuous training. At the moment, most of this takes place directly on patients during routine hospital activity, and attendance at practical teaching courses in experimental labs is exceptional.</p><p id="par0025" class="elsevierStylePara elsevierViewall">It has been estimated that around 50 video-assisted lobectomy procedures are needed to overcome the learning curve<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> over a recommended training period of up to 1 year,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> and to maintain a good performance level, each surgeon must perform at least 25 interventions a year.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There is a clear need to think beyond the “learn on patients” model, in order to reduce errors and increase patient safety. Simulation with tissue models in a wet lab is the most useful tool for this purpose.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a> Training directly on patients clashes with our commitment to offer them safe treatment and to avoid urgent conversions to thoracotomy due to intraoperative accidents.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> The preparation of resident doctors is a major challenge, and sufficient training must be offered in a safe environment that has the necessary caseload. In Spain, very few thoracic surgery units achieve the recommended number of procedures/surgeon/year.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In the Thoracic Surgery Department of Salamanca, we have developed a training program in minimally invasive surgery which also includes changes in the surgical environment to allow the more general application of these procedures, practice in high-volume hospitals, and practice in an experimental wet lab that uses prepared porcine heart–lung blocks for simulating VATS resections, principally left upper lobectomy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> This model has demonstrated high fidelity and is perhaps the most widely studied and validated for teaching VATS lobectomy.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,9</span></a> The left lung of the porcine heart–lung block model is not anatomically identical to human anatomy, but the tissues and advanced dissection techniques are reproducible and can be objectively evaluated by expert surgeons.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> It is also very inexpensive, although it must be used in facilities equipped with a video-assisted thoracoscopy machine.</p><p id="par0040" class="elsevierStylePara elsevierViewall">As Tong et al. mention, the utility of a task-based simulator depends on its fidelity and validity. Fidelity, also known as face validity, refers to how real the trainee feels the experience with the simulator to be. Content validity evaluates if the steps taken with the simulator are exactly those taken in the real procedure. Construct validity evaluates the ability of the simulator to discriminate between students with different levels of experience.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The few virtual simulators available, apart from being very expensive, are in the early stages of development and have not shown advantages over the porcine heart–lung model.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In all probability, the future will reveal that both platforms (virtual simulators and porcine heart–lung block) have advantages at different stages of VATS lobectomy training. The virtual reality platform may be used as often as required, and would be a good starting point for surgeons who are new to VATS lobectomy. As Carrott el al. state, the porcine model can then be used once surgeons gain some operative experience and will facilitate the development of fine dissection skills and gain a “feel” for tissue strength with sharp and blunt dissection of hilar vessels.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In the Hospital Universitario de Salamanca, we have been able to implement both training strategies to help generalize the use of VATS, which currently accounts for more than 80% of protocolized lung resection. To improve the training of the whole team, all procedures performed since the start of the program have been recorded for discussion in regular training meetings or “debriefings” and to evaluate times and skills.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In Spain, the surgical volume in many hospitals is low, and the specific training period is correspondingly short. For this reason, simulation is essential for properly teaching resident thoracic surgeons in such a short time. No universally accepted simulation strategy exists, and few centers have access to virtual or tissue simulators. A more uniform and accessible simulation strategy is needed for teaching and acquiring the skills required to perform VATS lobectomy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Jiménez López M, Novoa Valentín NM. ¿Cómo implementar un programa de lobectomía VATS en España? El laboratorio experimental (Wet Lab) es una herramienta necesaria. Arch Bronconeumol. 2016;52:579–580.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Video-assisted thoracoscopic surgery versus open lobectomy for primary non-small-cell lung cancer: a propensity-matched analysis of outcome from the European Society of Thoracic Surgeon database" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.E. Falcoz" 1 => "M. Puyraveau" 2 => "P.A. Thomas" 3 => "H. Decaluwe" 4 => "M. Hürtgen" 5 => "R.H. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 2 | 7 |
| 2024 October | 50 | 17 | 67 |
| 2024 September | 43 | 15 | 58 |
| 2024 August | 64 | 30 | 94 |
| 2024 July | 37 | 19 | 56 |
| 2024 June | 71 | 33 | 104 |
| 2024 May | 70 | 33 | 103 |
| 2024 April | 37 | 29 | 66 |
| 2024 March | 36 | 13 | 49 |
| 2024 February | 27 | 18 | 45 |
| 2023 March | 5 | 2 | 7 |
| 2023 February | 38 | 25 | 63 |
| 2023 January | 23 | 29 | 52 |
| 2022 December | 39 | 38 | 77 |
| 2022 November | 37 | 23 | 60 |
| 2022 October | 48 | 35 | 83 |
| 2022 September | 25 | 30 | 55 |
| 2022 August | 35 | 32 | 67 |
| 2022 July | 30 | 31 | 61 |
| 2022 June | 24 | 44 | 68 |
| 2022 May | 35 | 35 | 70 |
| 2022 April | 33 | 21 | 54 |
| 2022 March | 29 | 32 | 61 |
| 2022 February | 28 | 22 | 50 |
| 2022 January | 33 | 36 | 69 |
| 2021 December | 30 | 44 | 74 |
| 2021 November | 28 | 36 | 64 |
| 2021 October | 46 | 47 | 93 |
| 2021 September | 29 | 40 | 69 |
| 2021 August | 39 | 37 | 76 |
| 2021 July | 14 | 28 | 42 |
| 2021 June | 40 | 39 | 79 |
| 2021 May | 34 | 38 | 72 |
| 2021 April | 87 | 66 | 153 |
| 2021 March | 47 | 24 | 71 |
| 2021 February | 38 | 21 | 59 |
| 2021 January | 29 | 21 | 50 |
| 2020 December | 40 | 14 | 54 |
| 2020 November | 21 | 16 | 37 |
| 2020 October | 28 | 22 | 50 |
| 2020 September | 23 | 8 | 31 |
| 2020 August | 28 | 12 | 40 |
| 2020 July | 28 | 22 | 50 |
| 2020 June | 22 | 11 | 33 |
| 2020 May | 32 | 16 | 48 |
| 2020 April | 32 | 19 | 51 |
| 2020 March | 24 | 13 | 37 |
| 2020 February | 37 | 14 | 51 |
| 2020 January | 32 | 17 | 49 |
| 2019 December | 29 | 15 | 44 |
| 2019 November | 31 | 28 | 59 |
| 2019 October | 22 | 9 | 31 |
| 2019 September | 12 | 18 | 30 |
| 2019 August | 22 | 14 | 36 |
| 2019 July | 20 | 20 | 40 |
| 2019 June | 15 | 24 | 39 |
| 2019 May | 36 | 26 | 62 |
| 2019 April | 42 | 25 | 67 |
| 2019 March | 32 | 14 | 46 |
| 2019 February | 28 | 21 | 49 |
| 2019 January | 26 | 15 | 41 |
| 2018 December | 30 | 14 | 44 |
| 2018 November | 49 | 17 | 66 |
| 2018 October | 74 | 24 | 98 |
| 2018 September | 23 | 10 | 33 |
| 2018 May | 21 | 1 | 22 |
| 2018 April | 52 | 3 | 55 |
| 2018 March | 51 | 11 | 62 |
| 2018 February | 71 | 11 | 82 |
| 2018 January | 189 | 8 | 197 |
| 2017 December | 169 | 4 | 173 |
| 2017 November | 56 | 6 | 62 |
| 2017 October | 26 | 7 | 33 |
| 2017 September | 28 | 6 | 34 |
| 2017 August | 34 | 6 | 40 |
| 2017 July | 29 | 10 | 39 |
| 2017 June | 39 | 21 | 60 |
| 2017 May | 42 | 17 | 59 |
| 2017 April | 42 | 14 | 56 |
| 2017 March | 16 | 12 | 28 |
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