Thoracoscopy, historically known as pleuroscopy, refers to a diagnostic or surgical procedure that facilitates the direct visual examination of structures inside the thoracic and pleural cavities of the chest. Thoracoscopy is performed using a specialized instrument with an external light source and a lens for imaging on an external monitor. Video-assisted thoracoscopic surgery, or VATS, comprises a variety of techniques and procedures involving one or more small incisions. VATS typically requires either general anesthesia or local anesthesia combined with sedation. 

Thoracoscopy, a minimally invasive diagnostic and therapeutic procedure, allows clinicians to collect precise tissue samples from the pleura with the aid of sophisticated viewing equipment. Thoracoscopy enables surgeons to make reliable diagnoses when investigating abnormal pleural fluid or pleural thickening. Several diagnostic tests, such as computed axial tomography or transbronchial biopsy, also exist for diagnosing pleural pathology, but thoracoscopy exhibits a higher success rate in detecting pleural disease. 

About Dr. Gustavo Stringel: Gustavo Stringel, M.D., has presented and published research on several medical pulmonary topics, including video-assisted thoracoscopy. Currently holding the position of Surgeon in Chief at the Maria Fareri Children’s Hospital in Valhalla, New York, Dr. Stringel has performed a wide variety of laparoscopic procedures over the course of his career, including laparoscopic appendectomies, laparoscopic cholecystectomies, and diagnostic laparotomies.
 
 
In recent years, medical and surgical resident have been working fewer hours per week, in contrast to the 80+ hour-workweeks that were common in the past. Fortunately, we have options available to deal with the problem of the reduced workweek. In sum, we must enhance those hours our residents do spend on the job.
 
First, we must recognize that though all doctors have received training, not all have the same levels of cognition and psychomotor skills, and so we must tailor their training accordingly. Secondly, we can improve our ability to give feedback to the interns and residents under our supervision and provide honest, constructive critiques to help them learn. A key weapon in our training arsenal is the simulator. As medicine has become more sophisticated, so has our ability to train through simulations. While it is true that our simulators are not as sophisticated as flight simulators, for instance, certain skills can be acquired through repeated training in simulated surgeries.

Next, we can develop a system of meaningful rewards to motivate interns and residents to work harder during their reduced workweeks. Research has shown that people will work harder if they believe that their efforts will lead to rewards. Most residents are motivated, but they may become discouraged in the face of the constraints placed upon them by the hospital work environment and the relative loss of autonomy they experience as trainees. We must encourage residents to work around these obstacles.

Finally, we must never forget the circumstances that brought us to this point and strive to make the best use of whatever hours are available to us. Since we typically measure experience in terms of time, if we must reduce the time available to gain experience, we must make that time more meaningful.

 This article is a brief synopsis of points raised by Dr. Gustavo Stringel in his President’s Address to the Society of Laparoendoscopic Surgeons, which was published in the Society’s Journal in 2010. Dr. Stringel currently holds the posts of Surgeon in Chief and Director of Pediatric Surgery and Minimally Invasive Surgery at the Westchester Medical Center’s Maria Fareri Children’s Hospital.

 

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