Results of an exploratory survey within ESTS membership in 2022 on current trend of robotic-assisted thoracic surgery and its training perspectives

Abstract

Objectives: Robotic-assisted thoracic surgery (RATS) is increasingly used in our specialty. We surveyed European Society of Thoracic Surgeons membership with the objective to determine current status of robotic thoracic surgery practice including training perspectives.

Methods: A survey of 17 questions was rolled out with 1 surgeon per unit responses considered as acceptable.

Results: A total of 174 responses were obtained; 56% (97) were board-certified thoracic surgeons; 28% (49) were unit heads. Most responses came from Italy (20); 22% (38) had no robot in their institutions, 31% (54) had limited access and only 17% (30) had full access including proctoring. Da Vinci Xi was the commonest system in 56% (96) centres, 25% (41) of them had dual console in all systems, whereas RATS simulator was available only in half (51.18% or 87). Video-assisted thoracic surgery (VATS) was the most commonly adopted surgical approach in 81% of centres (139), followed by thoracotomy in 67% (115) and RATS in 36% (62); 39% spent their training time on robotic simulator for training, 51% on robotic wet/dry lab, which being no significantly different to 46-59% who had training on VATS platform. There was indeed huge overlap between simulator models or varieties usage; 52% (90) reported of robotic surgery not a part of training curriculum with no plans to introduce it in future. Overall, 51.5% (89) responded of VATS experience being helpful in robotic training in view of familiarity with minimally invasive surgery anatomical views and dissection; 71% (124) reported that future thoracic surgeons should be proficient in both VATS and RATS. Half of the respondents found no difference in earlier chest drain removal with either approach (90), 35% (60) reported no difference in postoperative pain and 49% (84) found no difference in hospital stay; 52% (90) observed better lymph node harvest by RATS.

Conclusions: Survey concluded on a positive response with at least 71% (123) surgeons recommending to adopt robotics in future.

Keywords: Conformite Europeenne; Robotic curriculum; Robotic-assisted thoracic surgery; Simulation; Thoracic surgery; Training; Video-assisted thoracoscopic surgery.

Figure 1:

Figure demonstrating types of robotic systems available in the institutions across the European Society of Thoracic Surgeons.

Figure 2:

Figure demonstrating dual console accessibility in the robotic systems.

Figure 3:

Scatter plot graph showing the direct relationship and the Spearman’s correlation index between dual console and availability of RATS simulator in trainee surgeons. RATS: robotic-assisted thoracic surgery.

Figure 4:

Bar graph chart showing Spearman’s correlation index between dual console and availability of RATS simulator with respect to training and independent robotic performers. RATS: robotic-assisted thoracic surgery.