Learning curve of image-guided video-assisted thoracoscopic surgery for small pulmonary nodules: A prospective analysis of 30 initial patients

Hsieh, Ming‐Ju; Chen, Wen; Fang, Hsin-Yueh; Wen, Yu-Wen; Lin, Chien-Cheng; Chao, Yin‐Kai

doi:10.1016/j.jtcvs.2017.11.079

Cited by 33 publications

(55 citation statements)

References 16 publications

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“…4 In similar procedures using thoracoscopic techniques, it has been shown that surgeons need to perform at least 50 procedures to feel comfortable, with even higher case volumes needed to decrease operative times. 11,12 At Boston Children's Hospital, the case volume per surgeon was not sufficient to trend operative times against experience, but with more clinical data, it would not be unreasonable to expect shorter operative times. Taken together, our data and that reported in the literature suggest that increased utilisation may eliminate differences in operative time compared to thoracotomy, while preserving the benefits of shorter hospitalisations and ICU stays.…”

Section: Discussionmentioning

confidence: 99%

Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus

et al. 2020

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Background: Patent ductus arteriosus closure is traditionally performed by thoracotomy approach. Video-assisted thoracoscopic surgery is a less frequently utilised alternative. We sought to compare elective surgical outcomes between the two methods via a single-centre retrospective cohort analysis. Methods: All patients >3.2 kg undergoing surgical patent ductus arteriosus ligation at a single institution from 2000 to 2018 were retrospectively reviewed. Propensity matching for age, weight, diuretic usage, and preterm status was conducted to adjust for differences in baseline patient characteristics. Outcome measures included operative time, hospitalisation duration, post-operative complications, and re-operation. Results: A total of 173 patients were included, 127 thoracoscopy and 46 thoracotomy. In the unmatched cohorts, no significant difference in closure success was found (94% thoracoscopy versus 100% thoracotomy, p = 0.192). Although median operative time was longer for thoracoscopy (87 versus 56 minutes, p < 0.001), hospitalisation duration was shorter (1.05 versus 2.41 days, p < 0.001), as was ICU stay (0.00 versus 0.75 days, p < 0.001). There were no significant differences in re-operation or complication rates, except chest tube placement (11% thoracoscopy versus 50% thoracotomy, p < 0.001). After matching (69 thoracoscopy versus 20 thoracotomy), these differences persisted, including median operative time (81 versus 56 minutes, p = 0.007; thoracoscopy versus thoracotomy), hospitalisation duration (1.25 versus 2.27 days, p < 0.001), and chest tube placement (17% versus 60%, p < 0.001). There remained no significant difference in complications or re-operations. Conclusions: Thoracoscopic ligation was associated with shorter ICU and hospital stays and less frequent chest tube placement, but longer operative times. Other risks, including bleeding, chylothorax, and recurrent laryngeal nerve injury, were similar.

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Section: Discussionmentioning

confidence: 99%

Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus

et al. 2020

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“…Several studies had described image-guided video assisted thoracoscopic surgery with marking in real time, in single suite, and immediate resection in a hybrid operating room. Those trials summarized many advantages of iVATS, such as (1) iVATS provides a less invasive approach and results in less discomfort for patients and improved postoperative recovery and general satisfaction; (2) complete and minimal resection of early lung cancer with optimal margin, allowing maximal preservation of patients' lung volume and function; (3) single use of anesthesia and the use of only one room improve both perioperative outcomes (e.g., shorter operative duration and length of hospital stay) and general cost-effectiveness; and (4) iVATS encourages early cancer treatment (1)(2)(3)(4)(5)(6). However, none of these studies demonstrated the utility of iVATS for bilateral lung nodule resection.…”

Section: Discussionmentioning

confidence: 99%

Bilateral lung nodules resection by image-guided video-assisted thoracoscopic surgery: A case series

Liang

Liao

Cheng

et al. 2020

Preprint

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Background We demonstrated the safety and feasibility of image-guided video-assisted thoracoscopic surgery (iVATS) of bilateral lung lesions in a hybrid operating room. Methods This study was a retrospective analysis of a case series. A total of 7 patients with 15 small lung nodules underwent bilateral iVATS between July 2018 and May 2019. All procedures were completed within a single anesthesia procedure and performed in a hybrid operating room that had a cone-beam computed tomography (CT) apparatus equipped with a laser navigation system. The lesion characteristics, operation methods, and peri-operative clinical outcomes were summarized. Results A total of 7 patients with 15 resected lung nodules were analyzed. The most common pathological result of our bilateral iVATS was metastasis. The median length of hospital stay was 5 days (range from 3 to 10 days). The median right chest tube duration was 2 days (range from 1 to 8 days), and the median left chest tube duration was 3 days (range from 2 to 5 days). Only one patient had a complication during his hospitalization period. There was no surgery-related mortality observed. Conclusions The bilateral iVATS procedure seems to be a feasible, safe and cost-effective approach for successful resection of bilateral lung lesions.

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“…Second, the lack of a control group (performing bronchoscopic and CT-guided procedure separately) makes it difficult to differentiate the specific benefits of combining the workflows into one step. Third, the procedures were not well standardized in some parts, especially when performing needle localization, and more cases are necessary to overcome the learning curve of using the iGUIDE system (15). Further investigations are necessary to clarify the applicability and benefits of this new localization method.…”

Section: Discussionmentioning

confidence: 99%

Single-stage hybrid localization: a combination of bronchoscopic lung mapping followed by post-mapping computed tomographic reconstruction and additional transthoracic needle localization in a cone beam computed tomography room

Yang

Meng³

et al. 2019

Ann. Transl. Med

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Learning curve of image-guided video-assisted thoracoscopic surgery for small pulmonary nodules: A prospective analysis of 30 initial patients

Abstract: Our data demonstrate a significant learning curve for image-guided video-assisted thoracoscopic surgery in the treatment of solitary pulmonary nodules as evidenced by decreased localization time and radiation exposure occurring with increased surgical experience.

Cited by 33 publications

References 16 publications

Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus

Comparison of outcomes following thoracoscopic versus thoracotomy closure for persistent patent ductus arteriosus

Bilateral lung nodules resection by image-guided video-assisted thoracoscopic surgery: A case series

Single-stage hybrid localization: a combination of bronchoscopic lung mapping followed by post-mapping computed tomographic reconstruction and additional transthoracic needle localization in a cone beam computed tomography room

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