Video-assisted thoracic surgery lobectomy: centers of excellence or excellence of centers?

VATS lobectomy, as defined by CALGB 39802, provides the same oncologic surgery as that performed through a thoracotomy. Standardizing the terminology is the first step that must be undertaken to standardize the operation. VATS lobectomy is the use of technology to aid in performing an established procedure. This technology and development of the skills required to perform a safe VATS lobectomy must be carefully monitored to protect the quality of the product, which ultimately is defined as patient outcome. "Center of Excellence" is a determination used in several other specialties to provide quality assurance for new procedures or technologies, or for those surgeries not widely performed, such as esophageal surgery. The authors believe that the profession should designate Centers of Excellence based on the credentialing guideline discussed earlier. The authors do believe that the current residency and fellowship training will provide, in time, ample surgeons skilled in VATS lobectomy. As these surgeons become certified and disseminate throughout the country, it is expected that VATS lobectomy will be readily available in most institutions. Over time this will allow VATS lobectomy to evolve from specific Centers of Excellence to a broader group of hospitals based on widespread availability ofa surgeon certified in VATS lobectomy. During this transition, the authors would encourage the community of surgeons performing this procedure to submit their statistics to a nationwide database. This will provide an excellent database for evidence-based medicine. Such rigorous data collection should permit thoracic surgeons to be appropriately compensated for performing these technically challenging procedures.