Safety and Performance of Clinical Engineers as Thoracoscopic Scope Operators

INTRODUCTION: In Japan, efforts are being made to reduce the workload of physicians by delegating certain tasks to clinical engineers (CE) serving as scope operators (SO) in thoracoscopic lung resections. METHODS: To evaluate the safety and learning curve of clinical engineer scope operator (CESO) assistants, we analyzed their performance in thoracic surgeries conducted at our hospital from 2020 to 2023. Surgical data and postoperative complications associated with video-assisted thoracic surgery (VATS) lobectomy were assessed using scope clearance sustainability (SCS). RESULTS: The proportion of CESO-assisted procedures increased from 37% (55/150 cases) in 2020 to 53% (97/183 cases) in 2023, with the cumulative number of CESO-assisted surgery hours reaching approximately 697 in 2023. No significant differences were observed between the CESO-assisted and non-CESO groups regarding operating time, blood loss, postoperative hospital discharge days, or drain removal days. However, a chi-square test revealed that pulmonary air leakage lasting more than 7 days was significantly associated with postoperative complications. Multivariate analysis identified incomplete interlobar fissure as the only independent factor associated with incomplete fissure, with no significant differences attributable to CESO involvement. The stability of CESO-assisted surgeries was evaluated during the introductory period. At the beginning of this period, 28 cases were required to achieve a stable technique, whereas only 18 cases were necessary by the end. Experience with VATS demonstrated that stable outcomes could be consistently achieved with the right upper lobectomy procedures. CONCLUSION: VATS with CESO assistance is a safe and reliable technique, with stability achieved within 20-30 cases.