Extensive open lobectomy experience is not a prerequisite for learning uniportal video‐assisted thoracic surgery lobectomy

Abstract

Background and objectives: Uniportal video-assisted thoracoscopic surgery (U-VATS) lobectomy has been increasingly adopted to manage early stage lung cancer. However, little information is available on whether this technique can be taught to surgeons inexperienced in open lobectomy. This study aimed to investigate the learning curve for U-VATS lobectomy performed by a single surgeon with limited open lobectomy experience.Methods: From July 2018 to September 2020, 103 patients received U-VATS lobectomy for lung cancer by a single surgeon. The learning curve was assessed using three statistical methods: the moving average analysis, cumulative sum (CUSUM) analysis, and risk-adjusted CUSUM (RA-CUSUM) analysis. Results:The moving average analysis showed a continuous decrease in operative time throughout the study period. The CUSUM analysis demonstrated three well-differentiated learning phases: Phase 1 (the initial 34 cases) representing the initial learning, Phase 2 (the middle 33 cases) representing the improvement of competence, and Phase 3 (the final 36 cases) representing technical proficiency.RA-CUSUM analysis revealed that the maximized cumulative surgical failure, defined as the maximum cumulative difference between the observed and predicted surgical failures, was found in the 61st case.Conclusions: U-VATS lobectomy is feasible for surgeons with limited open lobectomy experience. Multidimensional statistical analyses suggested that 61-67 cases were required to gain technical proficiency and ensure acceptable surgical outcomes.

Uniportal video-assisted thoracoscopic surgery for lobectomy: the learning curve

“…So far, only Zhai et al [ 12 ] reported a complication-based learning curve. Our reported number of cases required before a significant decrease in technique-related complications is shown (between 50 and 96 procedures), is in agreement with the 61 procedures as the initial learning phase of a single surgeon with limited open lobectomy experience published by Zhai et al [ 12 ].…”

“…So far, only Zhai et al [ 12 ] reported a complication-based learning curve. Our reported number of cases required before a significant decrease in technique-related complications is shown (between 50 and 96 procedures), is in agreement with the 61 procedures as the initial learning phase of a single surgeon with limited open lobectomy experience published by Zhai et al [ 12 ]. Whereas Zhai et al performed a learning curve on surgical failures which also included pneumonia, cardiac complications, subcutaneous emphysema, delirium, less than 10 harvested lymph nodes , and 30-day readmissions, we performed a complication-based learning curve on predefined technique-related complications.…”

“…Our learning curves on surgery duration demonstrated a decline after 14 to 26 procedures, which is in line with the previously reported number of procedures in the initial learning phase varying between 19 and 60 procedures ( Supplementary Material, Table S1 ) [ 5–12 ]. Our CUSUM analysis for surgery duration varied from the one which is mostly applied in literature, whereas the chart is incremented or decremented by the individual positive or negative difference with the mean of all data points of the procedures in chronological order [ 5–9 , 11 , 12 ]. Our analysis prevents a disproportionally large influence of relatively extreme prolonged surgery durations (e.g., complicated surgery, more complex procedures) on the surgeon’s learning curve.…”