Certification for minimally invasive thoracic surgery: is your surgeon ready?

The introduction of minimally invasive approaches in thoracic surgery has shown continued promise through a myriad of quality and oncology metrics. Studies have shown favorable comparative effectiveness between minimally invasive approaches and open resection of both benign and malignant pathology. Video-assisted thoracoscopic surgery continues to expand since the early 1990’s with versatility in its applications. Similarly, robotic-assisted thoracoscopic surgery ushered in another instrument into the thoracic surgeon’s armamentarium since its debut in 2000 with ongoing support and application for thoracic surgery with favorable results. Ongoing investigation and debate continues regarding advantages/disadvantages and cost effectiveness of video assisted versus robotic assisted thoracic surgery. Regardless, robotic thoracic surgery is here to stay with applications based on individual patient selection and surgeon preference. More recently, fast track or enhanced recovery after surgery pathways are pushing the limits of perioperative care with reduced length of stay, improved pain, and faster recovery with higher patient reported satisfaction and outcomes when paired with minimally invasive surgery. As such, surgical training for thoracic surgery presents new challenges for proficiency in both open and minimally invasive techniques in a realm where open approaches are utilized less often