Learning curve for uniportal video-assisted thoracoscopic surgery lobectomy—results from 120 consecutive patients

Liu, Xiaochuan; Chen, Xiaosang; Shen, Yaxing; Wang, Hao; Feng, Mingxiang; Tan, Liang; D’Amico, Thomas A.

doi:10.21037/jtd.2018.08.87

Cited by 27 publications

(24 citation statements)

References 27 publications

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“…Regarding the learning curve study, previous research mostly focused on lobectomy. [23][24][25][26][27] In the UVIG report, 71% of the surgeons deemed the cut-off number as 50 cases were required to achieve the proficiency phase. 23 Studies reporting the learning curve of uniportal thoracoscopic segmentectomy are scarce.…”

Section: Discussionmentioning

confidence: 99%

The learning curve for uniportal video‐assisted thoracoscopic anatomical segmentectomy

Wan

et al. 2021

Journal of Surgical Oncology

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Objectives: The aim of this study is to evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of uniportal thoracoscopic segmentectomy.Methods: We retrospectively analyzed the first 238 and 159 cases of uniportal thoracoscopic segmentectomy performed by two surgeons (A and B). The learning curves were assessed using cumulative sum analysis. Perioperative outcomes were evaluated as the learning curve developed. Two subtypes of this surgical approach, simple and complex segmentectomy, were separately analyzed.Results: Based on the learning curve, the inflection points occurred at 64 and 90 cases for surgeon A, 71 and 100 cases for surgeon B. Significantly longer operative time (p = .013), length of stay (p = .002), and drainage duration (p = .039) were observed between phase I and phase II compared to phase III for surgeon A.Operative times (p = .001) were significantly reduced for surgeon B. Furthermore, 26-28 and 52-56 cases were necessary to master the simple and complex segmentectomy, respectively.Conclusions: A total 64-71 cases were required to master uniportal thoracoscopic segmentectomy and 90-100 cases were necessary to achieve proficiency.

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Section: Discussionmentioning

confidence: 99%

The learning curve for uniportal video‐assisted thoracoscopic anatomical segmentectomy

Wan

et al. 2021

Journal of Surgical Oncology

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“…A reduction in the rate of postoperative PAL will not only avoid these complications, but will also contribute to a reduction in medical costs. However, other reports describing the learning curve of thoracoscopic surgery found no improvement in postoperative PAL (7)(8)(9)(10)(11)(12)(13)(14)(15). The difference may be due to the more sophisticated surgical techniques used during thoracoscopic surgery to dissect the fissure and thus expose the pulmonary artery or suture an air leak site.…”

Section: Discussionmentioning

confidence: 97%

“…The operative time, rate of postoperative PAL, and rate of intraoperative massive bleeding were assessed. While several reports have examined the learning curve in multiportal or uniportal thoracoscopic major pulmonary resection (7)(8)(9)(10)(11)(12)(13)(14), this is the first report in which the transition period from the traditional to less invasive procedure was considered.…”

Section: Discussionmentioning

confidence: 99%

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The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach

Igai¹,

Kamiyoshihara²,

Furusawa³

et al. 2021

J Thorac Dis

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Background: In some institutions, a recently introduced uniportal approach has replaced the multiportal approach for thoracoscopic major pulmonary resection. This study investigated the effect of this change on the surgical learning curve by examining the perioperative results of a single surgeon. Methods: Between April 2012 and August 2020, 376 patients with primary lung cancer underwent thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy in the authors' hospital. Surgery was performed by one of the authors in 189 of these patients, who were thus enrolled in this retrospective study. The surgeries were classified chronologically into five phases and the operative time, rate of intraoperative massive bleeding, and rate of postoperative prolonged air leak (PAL) were then compared. The learning curve (i.e., operative time) was assessed by Spearman's rank correlation test. The perioperative results achieved with the uniportal and multiportal approaches were also compared before and after the patients were matched for their characteristics based on the propensity score. Results: The five phases differed significantly with respect to the operative time and rate of postoperative PAL (P<0.0001, P=0.0061). The correlation between operative time and number of consecutive cases was also significant (r=−0.579, P<0.0001). Superior results in terms of operative time (P<0.0001), duration of postoperative drainage (P<0.0001), and rate of postoperative PAL (P=0.0034) were obtained using a uniportal rather than multiportal approach. Conclusions: The transition from a multiportal to a uniportal approach did not cause a decline in the learning curve of thoracoscopic lobectomy with ND2a-1/2 lymphadenectomy.

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“…In the revised papers we noticed that most of the authors studied their LC by dividing the patients who underwent a VATS lobectomy according to the chronological sequence of surgery. Vieira and Liu describe, for example, 3 phases: respectively these were the initial (first 60 lobectomies), the transitional [61-140] and the proficient phase for the first author and the ascending (first 30 lobectomies), the plateau and the descending phase [61-120] for the second one (11,12). With the same statistical division, Divisi and Zhao report their LC of VATS by dividing their lobectomies into 3 uniform groups based on their initial or late experience (13,14).…”

Section: The Lc Of Vats Lobectomymentioning

confidence: 99%

Review of the learning curve of video-assisted thoracic surgery & robotic-assisted thoracic surgery lobectomies—similarities and differences

Paladini¹,

Meniconi²,

Ghisalberti³

et al. 2021

Curr Chall Thorac Surg

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Video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS) are two different types of surgical approach for the treatment of early stage lung cancer. Technological innovations brought on the beginning of a new era in thoracic surgery in the last 20-30 years. A need for training led many thoracic surgery centers to study how the learning of these new techniques took place among their surgeons: the so-called learning curve (LC). This review aimed not only to evaluate the recent literature about the LC of these two minimally invasive techniques but also to point out what are the similarities and differences between the two techniques. We chose a total of 50 reports from papers published between 2008 and 2019: 30 about the LC of VATS lobectomy and 20 studies about the LC of RATS lobectomy. We observed a substantial overlap between the training of both techniques even though the LC of RATS appears to be shorter than VATS. There are common cornerstones in the two LCs like reduction of operating times, reduction of blood loss, more complete lymphadenectomy, conversion rate reduction; a minimum number of at least 50 cases for VATS and 20 cases for RATS are needed to overcome the initial phase of the LC. We noticed that the need for accessory thoracoscopic access is particularly reduced with experience in the LC of the single-port VATS while the evaluation of the docking time is uniquely taken into account for RATS as for the need of specific training for basic robotic skills.

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Learning curve for uniportal video-assisted thoracoscopic surgery lobectomy—results from 120 consecutive patients

Cited by 27 publications

References 27 publications

The learning curve for uniportal video‐assisted thoracoscopic anatomical segmentectomy

The learning curve for uniportal video‐assisted thoracoscopic anatomical segmentectomy

The learning curve of thoracoscopic surgery in a single surgeon and successful implementation of uniportal approach

Review of the learning curve of video-assisted thoracic surgery & robotic-assisted thoracic surgery lobectomies—similarities and differences

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