National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: the Italian VATS register evaluation

Divisi, Duilio; Bertolaccini, Luca; Barone, Mirko; Amore, Dario; Argnani, Desideria; Zaccagna, Gino; Solli, Piergiorgio; Rienzo, Gaetano Di; Curcio, Carlo; Crisci, Roberto

doi:10.21037/jtd.2017.11.133

Cited by 12 publications

(6 citation statements)

References 29 publications

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“…In particular, operative time, blood loss, and postoperative air leaks significantly decreased as a result of increased experience to dissect hilar vessels and pulmonary parenchyma. It was in line with the data of Italian VATS group 29 ; the conversion rate and the percentage of air leaks defined the expertise of surgeon in VATSL, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.…”

Section: Discussionsupporting

confidence: 78%

Bleeding during Learning Curve of Thoracoscopic Lobectomy: CUSUM Analysis Results

Fiorelli

Cascone

Carlucci

et al. 2022

Thorac Cardiovasc Surg

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Background The management of intraoperative bleeding during thoracoscopic lobectomy is challenging, especially for non-experienced surgeons. We evaluated intraoperative bleeding in relation to learning curve of thoracoscopic lobectomy, the strategies to face it, the outcomes, and the target case number for gaining the technical proficiency. Methods This was a retrospective single center study including consecutive patients undergoing thoracoscopic lobectomy for lung cancer. Based on cumulative sum analysis, patients were divided into early and late experience groups, and the differences on surgical outcomes, with particular focus on vascular injury, were statistically compared. Results Eight-three patients were evaluated. Cumulative sum charts showed a decreasing of operative time, blood loss, and hospital stay after the 49th, the 43th, and the 39th case, respectively. Early (n = 49) compared with late experience group (n = 34) was associated with higher conversion rate (p = 0.08), longer operative time (p <0.0001), greater blood loss (p <0.0001), higher transfusion rate (p = 0.01), higher postoperative air leak rate (p = 0.02), longer chest tube stay (p <0.0001), and hospitalization (p <0.0001). Six patients (7%) had intraoperative bleeding during early phase of learning curve, successfully treated by thoracoscopy in four cases. Patients with vascular injury (n = 6) compared with control group (n = 77) presented a longer operative time (p = 0.003), greater blood loss (p = 0.0001), and higher transfusion rate (p = 0.001); no significant differences were found regarding postoperative morbidity (p = 0.57), length of chest tube stay (p = 0.07), and hospitalization (p = 0.07). Conclusion Technical proficiency was achieved after 50 procedures. All vascular injuries occurred in the early phase of learning curve; they were safely managed, without affecting surgical outcomes.

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Section: Discussionsupporting

confidence: 78%

Bleeding during Learning Curve of Thoracoscopic Lobectomy: CUSUM Analysis Results

Fiorelli

Cascone

Carlucci

et al. 2022

Thorac Cardiovasc Surg

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“…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). On the other hand, many authors like Yao, Bedetti, Martin-Ucar, Gonfiotti and Cheng divide their cases into 2 groups: at the beginning and at the end of their period of study (15)(16)(17)(18)(19).…”

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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“…We believe that the aspects to be taken into greater consideration are both the acquisition of the technique obtained by a theoretical path followed by practice in the operating room with the support of a tutor or a senior surgeon and the young surgeon's ability to manage complications that need conversion in open thoracotomy. In our recent work (2) we analyzed data from 1679 patients enrolled in the Italian Registry of VATS lobectomies to evaluate the parameters focused on during the training period. Among these, the interesting data emerged from the analysis related to the conversion rate that, in agreement with Petersen et al (10), decreased as experience increased although this was maintained around 7-8% even at the end of the learning program.…”

Section: Commentmentioning

confidence: 99%

What is the best strategy program to acquire video-assisted thoracoscopic surgery lobectomy technique?

Divisi¹,

Zaccagna²,

Crisci³

2018

J. Thorac. Dis

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National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: the Italian VATS register evaluation

Abstract: The conversion rate and the percentage of air leaks seem to define the expertise of VATS lobectomy, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.

Cited by 12 publications

References 29 publications

Bleeding during Learning Curve of Thoracoscopic Lobectomy: CUSUM Analysis Results

Bleeding during Learning Curve of Thoracoscopic Lobectomy: CUSUM Analysis Results

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

What is the best strategy program to acquire video-assisted thoracoscopic surgery lobectomy technique?

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