More and more surgeons are showing interest in advanced video-assisted thoracoscopic procedures, yet many of them are still unsure of how to embark on this challenging program. The aim of this course is to go into technical details, tips and tricks and to share experience with experts. As thoracoscopic surgery presents a wide range of operative possibilities, with options such as hybrid video-assisted techniques or pure endoscopic ones, international experts in these different approaches will share their experience and discuss the pros and cons of each technique. For participants interested in training, hands-on sessions on live tissue (option B), as well as initiation on robots (option B) are organized. The program does not focus on theoretical aspects of advanced thoracoscopic procedures that can be easily found in congresses, such as theoretical background of VATS, benefits and limitations of VATS, analysis of results, controversies about indications...

HIGHLIGHTS

Technological aspects: the course will focus on practical technological aspects such as instrumentation, energy source and tissue approximation technologies,operating room set-up, robotics.
Approaches: use and location of access incisions, their benefits and limitations.
Tips and tricks.
Complications: one major session of the course will be devoted to the analysis and management of complications, based on videos.

TARGET AUDIENCE

This curriculum is designed to meet the requirements of experienced thoracoscopic surgeons, who are considering starting a VATS program and who seek practical and helpful information. Fellows and residents as well as thoracic surgeons with limited experience in advanced thoracoscopic procedures will also benefit from sharing their experience with experts and colleagues.

COURSE DIRECTOR

D. Gossot (FR)

FACULTY PANEL

K. Amer (UK), T. Batchelor (UK), F. Becmeur (F), E. Brian (F), H. Decaluwé (B), T.L. Demmy (USA), J. Dunning (UK), M. Durand (F), R. Flores (USA), D. Gonzalez Rivas (SP), C.C Huang (TW), S. Jheon (KOR), T. Kohno (J), F. Melfi (I), C. Peillon (F), R. Petersen (DK), A. Seguin-Givelet (F), A. Sihoe (HK), S. Swanson (USA), M. Tedde (BR), P.A. Thomas (F), W. Walker (UK), J.M. Wihlm (F), H.S. Wu (TW)

For nearly 30 years, advances in minimally invasive surgery have demonstrated several benefits for patients. Robotic surgery has emerged as the most advanced minimally invasive platform, with notable improvements over thoracoscopic surgery, including better illumination, superior dexterity, more versatile stapling technology, and improved energy devices. Over the last two decades in the evolution of robotic surgery, several techniques of practice standardization have been explored.

COURSE OBJECTIVES & HIGHLIGHTS

to describe the latest practices in standardization of common and complex robotic thoracic procedures
to provide a primer in building of robotic surgical teams
to emphasize non-technical skills that are important in developing a robotic thoracic program
to provide an opportunity for networking and interactions between trainees and experts
to share ideas and experiences in developing and advancing robotic thoracic programs

EDUCATIONAL METHODS

Full immersion in outstanding facilities
Interactive theoretical and video sessions between Faculty and course participants
2 half days robotic surgery training and practice on live tissue + cadavers if option C is chosen, including the latest generation of da Vinci® robotic systems

COURSE DIRECTORS

J.M. Baste (FR)

W.C. Hanna (CA)

COURSE PROGRAM

THURSDAY MARCH 25

FOR OPTION A AND OPTION B

8.00 AM Registration and welcoming of participants

8.30 AM Theoretical session
CURRENT AND FORTHCOMING TECHNOLOGIES FOR ADVANCED THORACOSCOPIC PROCEDURES

Current instrumentation and imaging system
Preoperative modelisation : concept and development
Preoperative modelisation : applications for VATS major pulmonary resections
Electromagnetic Navigation Bronchoscopy for the VATS surgeon
Simulation for the VATS surgeon
The future operating room of the VATS surgeon
How the Industry will help?

VATS : ONE NAME, DIFFERENT TECHNIQUES
The rationale fundamentals for various approaches

Single port technique
Thoracoscopic anterior approach
Thoracoscopic posterior approach
Subxiphoid approach
Alternative techniques

12.30 PM Lunch at the Institute

1.30 PM Video session
TIPS AND TRICKS

Exposure
Vascular control
Fissure and parenchymal division

FOR OPTION B (Option A: end of afternoon free)

2.30 PM Pre Lab Video Session:

Pre-surgical marking for segmentectomies using ENB

3.00 PM Practical session: TRAINING ON LIVE TISSUE (PIGS)
VATS procedures:

Completion of the fissure
Incision and open of the mediastinal pleura overlying the left lung hilum
Dissection of the common pulmonary vein and cranial lobar vein
Division of the cranial lobar vein with endo-GIA autostaplers or Ligasure
Dissection and division of the cranial lobar bronchus with linear autostaplers
Dissection of the pulmonary arteries one by one and division them with linear autostaplers or vessel-sealing devices
Left caudal Lobectomy.

Initiation to robotic surgery
Initiation to Electromagnetic Navigation Bronchoscopy with superDimension

6.30 PM End of session for OPTION B

FRIDAY MARCH 26

FOR OPTION A AND OPTION B

7.45 AM Evaluation of the previous day

8.00 AM Video session
THORACOSCOPIC LOBECTOMIES: HOW I DO IT?
Main technical steps and tricks with different standpoints
- Lower lobectomies
- Right Upper lobectomy
- Left Upper lobectomy
- Middle lobectomy
- Lymph node dissection

12.30 PM Lunch at the Institute

1.30 PM Video session
THORACOSCOPIC THYMECTOMIES

Left approach
Right approach
Bilateral approach
Subxiphoid
The robotic surgeon standpoint
Repairing the phrenic nerve

FOR OPTION A

2.30 PM Video session

Advanced procedures and/or unusual cases

FOR OPTION B

2.30 PM Practical session

TRAINING ON LIVE TISSUE (PIGS)
VATS procedures:

Completion of the fissure
Incision and open of the mediastinal pleura overlying the left lung hilum
Dissection of the common pulmonary vein and cranial lobar vein
Division of the cranial lobar vein with endo-GIA autostaplers or Ligasure
Dissection and division of the cranial lobar bronchus with linear autostaplers
Dissection of the pulmonary arteries one by one and division them with linear autostaplers or vessel-sealing devices
Left caudal Lobectomy.

Initiation to robotic surgery
Initiation to Electromagnetic Navigation Bronchoscopy with superDimension

5.00 PM End of session for OPTION A

6.30 PM End of session for OPTION B

8.00 PM Dinner in honor of the participants

SATURDAY MARCH 27

FOR OPTION A AND OPTION B
7.45 AM Evaluation of the previous day

8.00 AM Theoretical session
ROBOTIC THORACIC SURGERY

Principles
Lobectomies
Mediastinal tumors

DEBATES: robotic and thoracic surgery: pros & cons

TROUBLESHOOTING COMPLICATIONS: DESCRIPTION, MANAGEMENT AND PREVENTION

My complications: how many? what happened? how I did manage it? which lesson?

12.00 PM
Lunch-buffet at the institute
End of course
Delivery of certificates of attendance

Program may be subject to modifications

THURSDAY SEPTEMBER 9

FOR OPTION B AND OPTION C

7.45 AM Registration and welcoming of participants

8.00 AM Didactic lectures

History and Development of Robotic Surgery
Robotic Anatomic Lung Resection
- Review of Literature
- Standard Robotic Lobectomy (5 lobectomies)
- Segmentectomy and Complex Image-Guided Segmental Resection
- Advanced and Complex Procedures: Sleeve Resections, Pancoast Tumors
Robotic Resection of Anterior Mediastinal Tumors
- Review of Literature
- Thymectomy for Myasthenia Gravis
- Thymectomy for Early-Stage Thymoma
- Thymectomy for Advanced-Stage Thymoma

12.30 PM Lunch at the institute

FOR OPTION B AND OPTION C
1.30 PM Hands-on training on live tissue (mini-pigs)

Two to three trainees paired with an expert on a training robot to perform pulmonary lobectomy and thymectomy

6.00 PM End of the session

8.00 PM Dinner in honor of the participants

FRIDAY SEPTEMBER 10

FOR OPTION B AND OPTION C

7.45 AM Evaluation of the previous day

8.00 AM Didactic lectures

Robotic Resection of Middle and Posterior Mediastinal Tumors
Robotic Esophagectomy: different approaches
Robotic Training
- Technical skills
- Educational and Evaluation Models
Safety and Performance Measurement
- Non-Technical Skills in Robotic Surgery
- Data Collection and Quality Improvement Initiatives
- CRM in Robotic Surgery
Research and Innovation in Robotic Thoracic Surgery
- Medico-economic evaluation
- New instruments and Future Innovations
- New and Emerging Robotic Platforms

12.30 PM Lunch at the institute

FOR OPTION B
1.30 PM Hands-on training on live tissue (mini-pigs)

FOR OPTION C
1.30 PM Hands-on training on cadavers

Two to three trainees paired with an expert on a training robot to perform pulmonary lobectomy and thymectomy

6.00 PM End of the course
Delivery of certificates of attendance

Program may be subject to modifications

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