Thoracic Surgery Training Program

Goals and Objectives

General Thoracic Rotation

Overall Objective: Understand the anatomy, physiology, and pathophysiology of the disease processes outlined in the TSDA Curriculum Section I (Chest Wall), Section II (Lungs and Pleura), Section III (Trachea and Bronchi), Section IV (Mediastinum and Pericardium), Section V (Diaphragm), Section VI (Esophagus), Section IX (Thoracic Trauma), Section X (Transplantation), and Section XII (Minor Procedures). Develop clinical skills to diagnose and determine the most appropriate treatment plan for patients with these specific disease processes. Develop clinical / technical skills for intraoperative treatment, specifically to include lung resection, esophageal resection / reconstruction, and lung transplantation. Develop patient care skills for intensive care, elective postoperative care, and outpatient follow-up of patients undergoing general thoracic surgical procedures.

Specific Clinical Skills during first six months (all residents):

1. Develop knowledge sufficient to be an effective first assistant. The importance of first assisting cannot be overemphasized since it is not possible to be an effective operative general thoracic surgeon without being able to first assist.
2. Understand conduct of general thoracic surgical operations to include:
   1. All aspects of lung and esophageal function
   2. Anesthesia issues during lung resection and single-lung ventilation
   3. Understand intraoperative decision-making – i.e., how much lung to resection, how to reconstruct GI tract.
   4. Understand lung preservation during transplantation
   5. Guide ventilatory support in postoperative period
3. Develop independent skills in progression to include:
   1. Endoscopy
      1. Bronchoscopy
      2. Esophagoscopy
   2. Thoracic incisions
      1. Thoracotomy
      2. Abdominal
      3. Thoracoabdominal
      4. Cervical
      5. Transverse bilateral exposure
   3. Thoracic Infections
      1. Tube thoracostomy
      2. Decortication
   4. Lung resection
      1. Wedge resection
      2. Lobectomy
      3. Pneumonectomy
      4. Chest wall resection
   5. Esophageal resection
      1. Transhiatal esophagectomy
      2. Transthoracic esophagectomy
      3. Anti-reflux procedures
   6. VATS
      1. Physiology of one-lung ventilation with closed chest
      2. Lung biopsy
      3. Treatment of infection
   7. Donor Pneumonectomy for Lung transplantation
4. Understand techniques for reoperative thoracic resection
5. Understand techniques for extrapleural pneumonectomy

Specific Clinical Skills during second six months (thoracic track residents):

1. Develop independent skills in progression to include:
   1. Endoscopy
      1. Bronchial stent placement
      2. Esophageal stent placement
   2. Lung resection
      1. Extensive chest wall resection and reconstruction
      2. Extrapleural pneumonectomy
      3. Sleeve Lobectomy
   3. Esophageal resection
      1. Reoperative esophageal resection
      2. Reoperative anti-reflux procedures
   4. VATS
      1. Lobectomy
      2. Anti-reflux procedures
   5. Lung transplantation
      1. Single Lung
      2. Double Lung