Learning Curve for Uniportal Thoracoscopic Anatomical Pulmonary Segmentectomy

Abstract

Background. Video-assisted thoracoscopic segmentectomy has been considered to be an effective management in properly selected patients. Given the substantial technical difficulties, uniportal thoracoscopic segmentectomy is a challenging surgical procedure. The purpose of this study was to investigate the learning curve for uniportal thoracoscopic segmentectomy procedures. Methods. Prospectively collected data were retrospectively analyzed for a series of 124 consecutive patients undergoing uniportal thoracoscopic segmentectomy from August 2016 to September 2018. The learning curve for uniportal thoracoscopic segmentectomy was studied using cumulative sum (CUSUM) combined with risk-adjusted cumulative sum (RA-CUSUM) methods. Results. According to the CUSUM combined with the RA-CUSUM analyses, the learning curve for uniportal thoracoscopic segmentectomy was composed of three well-differentiated phases: cases 1 to 24, cases 25 to 57, and cases 58 to 124. With the procedures proceeded orderly, the operation time tends to progressively decrease. Conclusions. The uniportal thoracoscopic segmentectomy is considered to be a feasible and safe surgical procedure that can be taught to surgeons through a proctored learning curve. The data of the present study indicate that the inflection point for completion the learning curve was reached after a considerable number of 57 cases.

The learning curve for uniportal video‐assisted thoracoscopic anatomical segmentectomy

“…Chen et al 14 analyzed 124 cases of U-VATS segmentectomy by a senior surgeon and reported that operative time fell sharply around the 24th procedure, but continued and 33 surgeries were required to reach the performance plateau. Besides this, Liu et al…”

“…The rate of prolonged air leak in phase III was 3.4%, which was similar to the previous report. 14,28 One of the major challenges with U-VATS segmentectomy was whether we could guarantee the adequate dissection of lymph nodes.…”

“…Studies reporting the learning curve of uniportal thoracoscopic segmentectomy are scarce. Chen et al 14 analyzed 124 cases of U‐VATS segmentectomy by a senior surgeon and reported that operative time fell sharply around the 24th procedure, but continued and 33 surgeries were required to reach the performance plateau. Besides this, Liu et al found approximately 33 cases were required to master the uniportal thoracoscopic segmentectomy 13…”

“…Besides this, their sample size was relatively small. Chen et al 14 analyzed the learning curve by the CUSUM method. However, our study enrolled more patients with complex segmentectomy, which may be associated with prolonged learning phase.…”

“…So far, only two articles regarding the learning curve of U-VATS segmentectomy have been reported with a relatively small number. 13,14 Based on high-volume thoracoscopic segmentectomy in our center, in this study, we aimed to describe our experience of 238 and 159 cases of U-VATS anatomical segmentectomy by two surgeons and report on the associated learning curves. Furthermore, we investigated the learning curves of simple and complex segmentectomy, respectively, which would benefit the promotion of this promising technique.…”