The Very Experienced Time-honoUred Surgeons (VETUS) project.

Senior surgeons who completed their formal surgical training before the video-assisted thoracoscopic surgery (VATS) lobectomy era have had more experience with lobectomy via thoracotomy while their thoracoscopic training background contrasts from younger surgeons. However, this does not seem to have an unfavourable effect on their performance. Despite the literature recognising the critical points of influence of the learning curve for resident surgeons, limited data are focusing on the incremental performance of VATS lobectomy by senior surgeons. The Very Experienced Time-honoUred Surgeons (VETUS) project aims to understand this trend in the VATS group and to introduce an approach to the VATS lobectomy involving senior surgeon. The VETUS project is based on a self-assessment program where the senior surgeon (independently and in complete anonymity) follows a 1-year approach to training in VATS lobectomy. At predefined time intervals, the surgeon will be called to evaluate his performance according to a number of variables such as the choice of VATS lobectomy indications, the number of the port used and length of utility incision, time spent in dissecting the hilar structures and the overall percentage of VATS lobectomy performed in 1 year compared to open. The self-assessment of the VETUS project is a unique opportunity to define the path of a systematic approach to training outside the traditional modalities with the ultimate aim of supporting quality of standardised VATS lobectomy throughout the country.