Surgeons Say Minimally Invasive Lung Surgery Should Be Standard Care

Cincinnati—Major U.S. academic medical centers can successfully—and safely—integrate minimally invasive lung surgery into their training programs 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.

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. UC is one of only a handful of academic medical centers actively training surgeons to perform the procedure.

“Thoracoscopic lobectomy should be considered the standard of care for patients with early-stage lung cancers,” says Michael Reed, MD, assistant professor of surgery at UC and minimally invasive thoracic surgeon at 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 programs.”

Using this strategy, the UC surgeons have increased the number of minimally invasive lobectomies they perform by about 57 percent over four years. Reed estimates 75 percent of all lobectomies at University Hospital are now done using the minimally invasive approach.

Prior to implementation of the training program, only about 18 percent of lobectomies were performed minimally invasively.

Reed will present the findings on Friday, June 29, at the Western Thoracic Surgical Association’s annual meeting in Santa Ana Pueblo, New Mexico.

Reed and UC colleague Sandra Starnes, MD, conducted a four-year review of thoracic surgical cases at 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 program.

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 program into our practice was having a dedicated team of extensively trained thoracic surgeons with expertise in both open and minimally invasive, video-guided techniques,” adds 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 UC and is now in private practice at Evanston Hospital in Illinois.