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."
The 2024 Latin American Cardiovascular Surgery Conference, held over three days in Buenos Aires, Argentina, attracted leading experts from Europe, Latin America, and North America to address topics in cardiovascular medicine, including coronary artery disease, congenital heart disease, atrial fibrillation, and heart failure.
"The conference provided a diverse range of sessions to accommodate surgeons at all stages of their careers," explained Program Chair Rafael Sadaba, MD, Navarra University Hospital, Pamplona, Spain. “Residents and early career surgeons benefited from dedicated sessions, while experienced surgeons had the opportunity to delve into complex procedures and cutting-edge techniques.”
The program offered a comprehensive overview of the latest advancements in cardiac surgery. It featured scientific abstracts, technical videos, and interactive discussions on a variety of topics, including the current state of heart transplantation in Latin America, the use of mechanical circulatory support devices, the role of ECMO in treating cardiogenic shock, and advanced surgical techniques for mitral and aortic valve repair.
“This year, I was particularly interested in the session on the Ross Procedure, an operation that has been around for a long time but has experienced renewed interest over the past few years," said EACTS Secretary General Patrick Meyers, MD, Lausanne University Hospital, Switzerland.
The three-day event highlighted women's cardiac health, particularly tailored approaches and complex treatments for women of reproductive age. Other sessions focused on managing aortic dissection, advancing transcatheter valve therapies, and providing lifelong care for patients with conditions such as aortic stenosis.
The conference concluded with hands-on workshops that allowed participants to practice skills such as mitral valve repair and ECMO cannulation, making it an essential platform for advancing cardiac care in Latin America.
CHICAGO, IL – December 10, 2024 – Annals of Thoracic Surgery Short Reports (Annals Short Reports), The Society of Thoracic Surgeons’ peer-reviewed, open-access journal, has been accepted for indexing in PubMed Central,1 expanding its reach and impact within the global medical community. Beginning in early 2025, all articles that have been published in Annals Short Reports will be indexed and viewable and included in general search results on PubMed/MEDLINE.
A groundbreaking surgical achievement has been made by the team at West Virginia University (WVU) Heart and Vascular Institute, led by Dr. Vinay Badhwar, the executive chair of the WVU Heart and Vascular Institute and the second vice president of the Society of Thoracic Surgeons. On October 31, 2024, the team performed the world’s first combined robotic aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) through a single small incision.
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Dr. Vinay Badhwar
The pioneering procedure was performed on 73-year-old Poppy McGee, a patient with a complex medical history, including a stroke, brain surgery, and significant weight loss. Referred to Dr. Badhwar for treatment of both aortic valve disease and coronary artery disease, McGee initially faced the prospect of traditional open-heart surgery. However, when she and her family learned of its risks—over a 10% chance of mortality and nearly 50% likelihood of complications—they inquired about alternative options.
Dr. Badhwar explained his team had developed a novel robotic approach that had yet to be tested on a patient. After a thorough discussion of the risks and benefits, McGee and her family agreed to proceed with the innovative robotic surgery.
The procedure involved both AVR and CABG, performed entirely robotically through a single incision on the far right of McGee’s chest. The success of the surgery has sparked optimism about the potential for broader adoption of robotic heart surgery for patients with complex conditions.
“While we are still in the early days of this latest innovation, the ability to perform valve surgery and coronary artery bypass surgery fully robotically through a single incision has the potential to open up a new era of robotic heart surgery,” Dr. Badhwar noted in a prepared statement. “We must always keep quality outcomes at the forefront of all innovation. However, if surgeons adopt and gain experience with techniques such as this one, they will tackle this last frontier that previously limited a robotic approach. One day in the near future, this may serve as a platform to perform nearly all types of heart surgery.”
This revolutionary procedure potentially paves the way for less invasive operations. Dr. Lawrence Wei, a professor at the WVU Department of Cardiovascular and Thoracic Surgery, remarked on the impact of this advancement: "Patients who have both valve disease and coronary artery disease have traditionally been treated by open-heart surgery performed through the breastbone. This new robotic technique could redefine how we approach these cases."
Dr. Goya Raikar, an assistant professor at WVU and a member of Badhwar’s robotics team, also underscored the procedure's significance: "Until now, the main exclusion for us to perform a robotic approach has been the coexistence of valve and coronary artery disease. Building on our experience with robotic aortic valve surgery, this new approach may help us extend robotic surgery options to many more patients."
The patient’s daughter, Mollie Wilcosky, expressed gratitude for the groundbreaking care provided by the WVU team. “We are so thankful for Dr. Badhwar and the team at the WVU Heart and Vascular Institute for developing this robotic procedure to help my mother recover so well,” Wilcosky said. “She is getting stronger every day.”
The full details of the procedure will be in The Annals of Thoracic Surgery, highlighting how innovative approaches like this continue to redefine the future of cardiothoracic surgery.
References:
• Cardiovascular Business article on the WVU Heart and Vascular Institute's groundbreaking surgery.
• WV News article detailing the multidisciplinary team and procedural innovations at WVU Medicine’s WVU Heart and Vascular Institute.
The Society of Thoracic Surgeons (STS) and the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS) recently co-hosted the inaugural Aortic Summit 2024 in Tokyo, Japan. This international event brought together leading experts in the field to discuss advancements in the diagnosis and treatment of thoracic aortic lesions, including endovascular approaches.
The summit was designed to cater to a diverse audience, including cardiothoracic surgeons, cardiac anesthesiologists, CT residents, perfusionists, and ICU and OR nurses.
The comprehensive three-day program covered a wide range of topics, including root, arch, descending aorta, TEVAR, dissection, and hybrid procedures. Participants had the opportunity to learn from experts, network with colleagues, and gain valuable insights into the latest techniques and technologies.
"The sessions delved into the latest developments through a series of presentations, panel discussions, and hands-on workshops," said Yutaka Okita, MD, Congress President for the STS-ASCVTS Aortic Summit 2024. "The event featured a number of eminent speakers from all over the world, who shared their expertise and achievements with attendees.”
On October 25-26, 2024, more than 230 members of perioperative and critical care teams from around the world gathered in Philadelphia for the 2024 Perioperative & Critical Care Conference. The conference focused on the latest techniques and management strategies in cardiovascular and thoracic critical care, as well as enhanced recovery after surgery. Participants gained valuable insights and practical strategies aimed at optimizing patient care and improving outcomes.
The two-day event covered a wide range of topics, including fundamentals of waveforms and monitoring, goal-directed hemodynamic therapy and AKI prevention, ECMO fundamentals, improving communication in the cardiothoracic intensive care unit, and vasoplegia management.
Here's what a few attendees said about the Perioperative & Critical Care Conference:
"In the ECMO session, we not only saw the latest in technology and innovation, but also learned techniques that will help us treat our patients and get them out of the hospital in better condition,” Dr. Jeremiah Hayanga, West Virginia University Health System
"The conference was well-paced and engaging. The speakers were captivating, and the discussions were thought-provoking. The two days flew by!"
"The STS team did a fantastic job with the logistics of this large-scale conference. The recordings and slides will be a great way to review the material and share it with colleagues.”
"The conference was informative and highlighted areas where we can improve our practices. I appreciate the multidisciplinary focus, which is essential for optimal patient care."
"As an APP, I truly enjoyed the conference and felt that the presentation and topics aligned well with my role. I look forward to attending again next year."
A traveling, mobile lung screening program has the potential to diagnose cancer earlier, leading to a higher cure rate and lower death rate. In this episode of Thinking Thoracic, STS’s new podcast series, host Dr. Jeffrey Yang talks with Dr. Robert Headrick about CHI Memorial’s “Breathe Easy” mobile lung screening program and how meeting people where they are with quality healthcare services like this one is saving lives.
It is time to reconsider the management of Aortic valve Disease (AVD) across the world. In South Asian and Sub-Saharan African nations, in low-income countries, AVD is treated with surgical aortic valve replacement (SAVR). Patients receive mechanical valves. The population is younger than in high-income countries and the disease is different, mostly of rheumatic origin.
CHICAGO, IL – October 17, 2024 – The Society of Thoracic Surgeons (STS) announces the release of two new risk calculators to inform physician-patient decision-making in thoracic surgery. Engineered using contemporary data from the STS General Thoracic Surgery Database, these interactive tools provide surgeons with accurate, preoperative risk estimations for outcomes of esophagectomy for cancer and pulmonary resection for lung cancer.
More than 100 cardiothoracic surgeons, fellows, residents, and advanced practice providers participated in the 2024 STS Mastering Valve Surgery Workshop in Chicago on Sept 20-21. The two-day event included lectures, case-based presentations, and breakout sessions focused on mastering modern-day valve surgery, including open and transcatheter procedures for aortic, mitral, and tricuspid valves.
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Attendees participate in a hands-on aortic valve surgery session.
"This workshop stands out for its unique blend of theoretical instruction and practical hands-on training, covering both surgical and transcatheter techniques for all valve types," said co-course director Tsuyoshi Kaneko, MD, of Washington University in St. Louis. "The active participation and insightful questions from both domestic and international attendees highlighted the course's relevance and impact."
Attendees honed their skills through small-group, hands-on experiences in wet lab settings to learn the latest in advanced valve techniques (aortic root enlargement, Ross Procedure, minimally invasive valve surgery), transcatheter therapies, and atrial fibrillation.
"I'm pleased that the valve surgery courses encompassed both traditional surgical techniques and emerging transcatheter procedures," said co-course director Katherine Harrington, MD, of Baylor Scott & White Health in Dallas. “To remain at the forefront of the latest technologies in the field, we must continually update our knowledge and ensure our outcomes are exceptional, fostering collaboration with structural heart experts."
Here's what a few attendees said about the Valve Surgery Workshop:
"I enjoyed the panel discussions at the end of each session and found the small-group wet labs extremely helpful.” — Alex Wang, physician assistant, Johns Hopkins Health System
"The best sessions were aortic root enlargement by Dr. Yang, mitral valve surgery by Dr. Badhwar, and TAVR explant by Dr. Kaneko."
"Overall, it was a valuable experience to interact with experts and directly view the pig heart. The catheter-based procedure simulators were also helpful for learning."
"Great courses and discussion topics, exemplary faculty, and I enjoyed the hands-on sessions."
"Moving forward, I will adopt the aortic root enlargement technique as explained by Dr. Yang, the mitral valve replacement technique of Dr. Badhwar, and the Ross Procedure technique detailed by Dr. El-Hamamsy. I also intend to incorporate the maze and atrial clip procedures more frequently into my practice."
