A method of assessing reasons for conversion during video-assisted thoracoscopic lobectomy.

Conversion rates during video-assisted thoracoscopic lobectomy are reported, but no previous publications have classified the cause of conversion. The aim of the study was to develop a quality assessment tool [vascular, anatomy, lymph node, technical (VALT) 'Open'] to evaluate reasons and nature of conversion during the development of a video-assisted thoracoscopic lobectomy program. Between 2006 and 2008, 237 patients with a median age of 65 years underwent video-assisted thoracoscopic lobectomy primarily for lung. The number of video-assisted thoracoscopic lobectomy cases over open cases has increased over the period. Conversion rate has dropped from 15% (2006) to 11% (2008). A total of 32 cases required conversion. The VALT 'Open' classification for reason to convert and nature of conversion was used. The average length of stay was shorter for non-converted cases. No uncontrolled conversions where the patient was unstable were required, and in the 14 cases converted following some difficulty, such as pulmonary artery injury. A pattern to the learning curve became predictable. The quality assessment tool used (VALT 'Open') will allow cause of conversion and nature of conversion to be tracked and audited during the development of a video-assisted thoracoscopic surgery lobectomy program.