The evolution of the contemporary thoracic surgeon: open surgery versus video-assisted thoracic surgery teaching—a clinical practice overview

During the past few decades, thoracic surgery has been in constant evolution from open to more refined minimally invasive surgery techniques. Teaching and learning, in parallel with proficiency, competence and mastery are subject of debate nowadays. The aim of this paper is to describe the role of open surgery and video-assisted thoracic surgery (VATS) during training of the contemporary thoracic surgeon. The authors describe the learning process in different areas and phases throughout the paper. Open surgery, although less and less frequent, mainly for simple procedures, should not be under evaluated as it provides a unique source of learning opportunities. VATS, although globally adopted as the gold standard, must be part of any training program. Both open surgery and VATS provide complimentary learning methods and techniques and should happen simultaneously, not in a competitive way. Globally, despite the efforts from some institutions and experts, most countries do not present a unified and standardized approach to teaching new procedures. Introduction of standardized methods for quantification of training are recommended. Simulators, dry and wet labs and step-by-step programs should be implemented. The authors recommend implementation of surgical learning programs that have a rationale in their core that involves gradual evolution, including both open surgery and VATS to complement each other, and to create a training that is simultaneous and not competitive.