Is the learning curve for video-assisted thoracoscopic lobectomy affected by prior experience in open lobectomy?: Table 1.

Abstract

A best evidence topic was written according to a structured protocol. The question addressed is the learning curve for video-assisted thoracoscopic (VATS) lobectomy affected by prior experience in open lobectomy? Two hundred and two studies were identified of which seven presented the best evidence on the topic. The authors, date, journal, country of publication, study type, participating surgeon and relevant outcomes are tabulated. The studies presented discuss the learning experiences of surgeons with a range of proficiency in open lobectomy in performing VATS lobectomy. Four of the studies made direct comparisons between the outcomes achieved by trainees and fully qualified surgeons. Trainees performed a total of 154 VATS lobectomies and the consultants performed 714. The reported number of open lobectomies performed by trainees ranged 14-50. In one study, a qualified surgeon who had performed 100 open lobectomies achieved a statistically significant progression in his learning curve and was able to safely perform VATS lobectomies after 6 months. A trainee who had performed only 14 open lobectomies achieved a similar blood loss to his experienced supervisors (P = 0.79). Two trainee surgeons who had each performed at least 20 open lobectomies achieved similar mean intraoperative blood loss (P = 0.2) and complication rate (P = 0.4) to their experienced consultant when performing VATS lobectomy. Average duration of chest drainage was similar between consultant and trainee groups (P = 0.34) and was improved in favour of trainees in one group (P < 0.001); this might be due to the fact that they operated on more technically straightforward cases. Four trainee surgeons who had performed at least 50 open pulmonary resections each managed to achieve a similar mean operative time to their consultant in their first 46 cases, and a lower morbidity (26 vs 34.7%). There was no increase in mortality in the trainee groups. Surgeons with limited experience in open lobectomy can achieve good outcomes in VATS lobectomy comparable with their more experienced seniors.

Single- versus multiple-port thoracoscopic lobectomy for lung cancer: a propensity-matched study

“…The results suggested that SP was safe after practice with a relatively small number of cases. Similar findings were reported in recent papers [22,23].…”

Learning curve and established phase for uniportal VATS lobectomies: the Papworth experience

“…The experience of the surgeon in training is another important factor, as understanding the anatomy of the lung with the many anatomical variations makes the learning curve shorter. Okyere et al (15) state that the learning curve for multiportal VATS lobectomy is not eliminated by prior experience in open lobectomy and that junior surgeons with less experience in open lobectomy are able to demonstrate similar outcomes and similar learning curves to their more experienced counterparts (11). Is this true also for the switch from multiportal to uniportal?…”

Management of acute postoperative pain with continuous intercostal nerve block after single port video-assisted thoracoscopic anatomic resection

“…Due to the limitation of this study, we dare not to jump to conclusion. A further prospective study is warranted Initially, five cases were excluded from this study due to learning curve effects since every procedure needs a certain number of cases to reach relatively stable performance (23,24). In our surgical team, the operator and two assistants are all experienced surgeons who have done more than one hundred cases of conventional VATS anatomic resection.…”