How many Navs and Ebus til you're comfortable?

[ILikeMilk]

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Whats the data show and what is your guys' personal experience?

 

[jdh71]

Whats the data show and what is your guys' personal experience?

both really depend on your number of non-EBUS and NAV bronchs to begin with . . .

but if you have 300+ bronchs you'll be fine with either one from the scope perspective

once you've done 10 EBUS and KNOW your way around the anatomy by U/S then you're fine

NAV is more of an art form and sounds much easier on paper than it is practically speaking - it requires PATIENCE and the willingness to appreciate nuance and think cleverly - I think 30-50 cases to start feeling like you have the basics down and closer to 150 before you've got a thing down nicely with regards to case selection and strategy of approach to the lesion.

You can do one EBUS a month and be fine. You can't really only do one NAV a month and expect really to get better. If you don't have a set-up that allows you to do a case or two a week most weeks, then I wouldn't even recommend doing NAV - refer to someone that does more

 

[ILikeMilk]

both really depend on your number of non-EBUS and NAV bronchs to begin with . . .

but if you have 300+ bronchs you'll be fine with either one from the scope perspective

once you've done 10 EBUS and KNOW your way around the anatomy by U/S then you're fine

NAV is more of an art form and sounds much easier on paper than it is practically speaking - it requires PATIENCE and the willingness to appreciate nuance and think cleverly - I think 30-50 cases to start feeling like you have the basics down and closer to 150 before you've got a thing down nicely with regards to case selection and strategy of approach to the lesion.

You can do one EBUS a month and be fine. You can't really only do one NAV a month and expect really to get better. If you don't have a set-up that allows you to do a case or two a week most weeks, then I wouldn't even recommend doing NAV - refer to someone that does more

Thanks for the reply! For context, I'm a first year fellow just trying to estimate how many I'll have at the end of fellowship and also deciding on whether Navs are something I'd want to do in the future. I probably have around 30 bronchs, 15 EBUS, 3 super d, and 3 veran so far. by the end of fellowship I should have 50+ EBUS, 20+ Navs.

 

[jdh71]

Thanks for the reply! For context, I'm a first year fellow just trying to estimate how many I'll have at the end of fellowship and also deciding on whether Navs are something I'd want to do in the future. I probably have around 30 bronchs, 15 EBUS, 3 super d, and 3 veran so far. by the end of fellowship I should have 50+ EBUS, 20+ Navs.

that should be enough to 1) know if you like doing them enough that you want to continue and 2) enough numbers to feel comfortable starting a practice where you will do them provides you will get a few NAV cases per week most weeks.

I don’t really like NAV that much to be honest but I think my patients currently need be to be providing the service (in appropriate cases) and sometimes it can be pretty rewarding. But if we ever get a new hotshot out of fellowship who wants to do a ton because they like them I’d have no big problems giving it up.

I also have been hanging in there for the promise of better technology related to the NAV.

 

[Bobblehead]

Make sure your time is justified for the navs. The billing codes I use don't cover my time but it's a service we provide nonetheless. You're just going to have to make it back in another ways.

I think for EMN case selection is the most important aspect. So if you have a breadth of other things you do and therefore don't "need" to book cases that are presented to you, you can be more selective, get better success rates and frustrate yourself and the patients less.