Thoracic Surgery (Integrated) ACGME case minimums
Residents in Thoracic Surgery (Integrated) have a published ACGME minimum in 82 of 83 case categories, and the largest single minimum is 415. Each row below cites the ACGME requirement it was read from.
By Chris, CA-1, anesthesiology
Thoracic Surgery (Integrated) minimums by category
| Category | Thoracic pathway | Cardiothoracic pathway | Cardiac pathway |
|---|---|---|---|
| Congenital Heart Disease | 10 | 20 | 20 |
| Primary Surgeon | — | 5 | 5 |
| First Assistant | 10 | 15 | 15 |
| Acquired Valvular Heart Disease | 30 | 60 | 90 |
| Aortic Valve Repair/Replacement | 15 | 25 | 25 |
| Mitral Valve Repair/Replacement | 5 | 15 | — |
| Mitral Valve Repair | — | — | 10 |
| Mitral Valve Replacement | — | — | 5 |
| Tricuspid Valve Repair/Replacement, Annuloplasty | 5 | 5 | 5 |
| TAVR as primary | — | 5 | 20 |
| TAVR as assistant | 5 | 10 | 20 |
| Transcatheter Mitral/Tricuspid Intervention | — | — | 5 |
| Myocardial Revascularization | 35 | 80 | 80 |
| Primary CABG | — | — | 60 |
| Complex CABG (Multiple Arterial, Hybrid, Beating Heart, Redo) | — | — | 20 |
| Redo Sternotomy** (Can be double counted with any cardiac procedure; not counted in Adult Cardiac Total) | 5 | 15 | 15 |
| Interventional Wire-Based Procedures | — | 5 | 35 |
| Left heart catheter, PCI, TEVAR, Mitral Clip | — | 5 | 20 |
| Intravascular ultrasound** (may be double counted)No published minimum | — | — | — |
| Transeptal puncture** (may be double counted) | — | — | 10 |
| Ultrasound guided access** (may be double counted) | — | — | 5 |
| Conduit Dissection and Preparation - Open or endoscopic saphenous/radial vein harvest and preparation** (Can be double counted with CABG) | 5 | 5 | 10 |
| Radial Artery Harvest (open or endoscopic) | — | — | 5 |
| Saphenous Vein Open Harvest | — | — | 5 |
| Aortic Procedures - Any combination of ascending aorta/aortic root replacement, descending aortic replacement, aortic dissection, aortic trauma** (Can be double counted with CABG/Valve Procedures) | 5 | 10 | 25 |
| TEVAR and EVAR | — | 5 | 15 |
| Aortic Root Replacement (including VSRR or Composite Valve Graft) | — | — | 5 |
| Replacement of Ascending Aorta, Arch, Descending Aorta; Surgery for Aortic Dissection | — | — | 5 |
| Arrhythmia Surgery | — | 10 | 15 |
| Left atrial or biatrial maze, pulmonary vein isolation, right-sided maze, isthmus ablation ** (Can be double counted with CABG/ valve procedures) | — | 5 | 10 |
| Pacemaker insertion or pacemaker removal | — | 5 | 5 |
| Cardiopulmonary Bypass Set-up and Pump Run with Perfusionist | 5 | 5 | 5 |
| Circulatory Assist - Any combination of ECMO, VAD** (Can be double counted with another operation) | 10 | 20 | 35 |
| Intra-aortic balloon pump | 5 | 10 | 5 |
| Ventricular Assist Device Implant (Temporary Endovascular, Paracorporeal Ventricular Assist or implantable Durable Ventricular Support) | — | — | 15 |
| Extracorporeal membrane oxygenator support (VA or VV) | — | — | 10 |
| Thoracic Transplant (any combination of heart or lung implant, heart, or lung procurement) | — | — | 5 |
| Subtotal Adult Cardiac (and Congenital Heart Disease) Experience (Note: The American Board of Thoracic Surgery does not include congenital cases in this total number) | 100 | 215 | 315 |
| Lung | 105 | 60 | 45 |
| Major anatomic resections: open, VATS, or RATS (segmentectomy, lobectomy, pneumonectomy, lung transplantation**) **Only 1 pneumonectomy can be counted along with bilateral lung transplant. | 50 | 30 | 30 |
| VATS/RATS lobectomy specifically | 25 | 5 | — |
| Open or VATS lung biopsy/wedge resection | 30 | 25 | — |
| MIS Lobectomy, Biopsy, Wedge Resection | — | — | 15 |
| Pleura | 25 | 10 | 10 |
| Major (empyema decortication, pleurectomy decortication, other pleural tumor resection) | 5 | — | — |
| Minor (biopsy, pleurectomy, VATS sympathectomy, VATS Bleb resection, VATS pleurodesis, evacuation of hemothorax) | 15 | — | — |
| Interventional: In-dwelling cuffed pleural catheter insertion | 5 | — | — |
| Chest Wall and Diaphragm - Chest wall resection**, rib resection, rib plating, pectus repair, diaphragm resection or plication, repair of Morgagni, Bochdalek, traumatic hernia (**chest wall resection may be double counted with pulmonary resection) | 10 | 5 | 3 |
| Mediastinum - Tumor/cyst/mass resection via open, VATS, or robotic technique | 10 | 5 | — |
| Tracheobronchial - Airway Surgery** - Tracheal resection, laryngotracheal resection, sleeve lobectomy, carinal pneumonectomy, transplantation airway anastomosis (**Sleeve lobectomy and carinal pneumonectomy can be double counted with major anatomic lung resection) | 5 | — | — |
| Esophagus | 35 | 10 | 5 |
| Esophagectomy (Open or MIE) | 20 | 5 | — |
| Benign Esophagus: Repair of perforation, drain perforation, diverticulectomy, myotomy, hiatal hernia repair | 10 | 5 | — |
| Laparoscopic hiatal or paraesophageal repair | 5 | — | — |
| Subtotal General Thoracic Experience | 190 | 90 | 63 |
| TOTAL MAJOR OPERATIVE EXPERIENCE | 290 | 305 | 378 |
| Bronchoscopy | 40 | 30 | 20 |
| Simple (BAL, diagnostic, TBBx, Bx) | 30 | — | — |
| Complex (laser, dilation, stent, navigational bronchoscopy, photodynamic therapy, cryotherapy) | 10 | — | — |
| UGI - Endoscopy | 30 | 10 | 5 |
| Simple (diagnostic, Bx) | 20 | — | — |
| Complex (dilation, stent, EUS, EMR) | 10 | — | — |
| Mediastinal Assessment | 55 | 15 | 10 |
| Mediastinoscopy, Chamberlain (mediastinotomy) | 15 | 5 | — |
| EBUS/FNA | 10 | — | — |
| Mediastinal node dissection/systematic sampling during lung resection | 30 | 10 | — |
| Subtotal Minor Procedures | 125 | 55 | 35 |
| TOTAL OPERATIVE EXPERIENCE | 415 | 360 | 413 |
| CT Critical Care Index Case (CCIC) log | 20 | 20 | 20 |
| Junior residents must have at least 150 American Board of Surgery (ABS) core cases in the first three years (from the above list). | 150 | 150 | 150 |
| Vascular | 25 | 25 | 25 |
| Skin, Soft Tissue, Breast | 10 | 10 | 10 |
| Head/Neck | 5 | 5 | 5 |
| Alimentary tract | 20 | 20 | 20 |
| Abdomen | 30 | 30 | 30 |
| Operative Trauma | 5 | 5 | 5 |
| Pediatric | 10 | 10 | 10 |
| Plastic | 5 | 5 | 5 |
| Lap-basic | 30 | 30 | 30 |
| Lap-advanced | 10 | 10 | 10 |
| At least another 125 cardiothoracic cases are required in the first three years as well, but 50 of these cardiothoracic cases may come in the form of "component cases" (including but not limited to sternotomy and closure, thoracotomy and closure, LIMA takedown, saphenous vein harvest, aortic and venous cannulation, proximal and distal anastomosis, other vascular anastomosis, gastric/esophageal mobilization) while on the cardiac, thoracic, and congenital services. | 125 | 125 | 125 |
| In addition to the 275 cases specified above, another 100 must come from either the ABS list or from cardiothoracic cases. | 100 | 100 | 100 |
| The total number of cases in the first three years of the I-6 must meet or exceed 375 cases, or 125 per year. | 375 | 375 | 375 |
An em-dash means the ACGME publishes no minimum on that row — not a minimum of zero.
Thoracic Surgery (Integrated) · ACGME specialty 461.
Capnolog counts these live for anesthesiology and neurological surgery; other specialties are reference only.
What counts toward a minimum?
- Residents log cases into categories the ACGME defines, not by procedure code.
- Each minimum is read in its own column: “Thoracic pathway”, “Cardiothoracic pathway” and “Cardiac pathway”.
- 54 rows are drawn from a larger row: those cases count toward that row too, never on top of it.
- 1 row carries no published number and shows an em-dash, which is not a minimum of zero.
- The ACGME Review Committee that accredits Thoracic Surgery (Integrated) programs sets these requirements.
Where do these numbers come from?
- Case Log categories and minimum numbers, October 2022
- Program Requirements, July 1, 2026
Capnolog is independent of the ACGME. Where a number here and the ACGME's own document disagree, the document is right.