The learning curve for uniportal video‐assisted thoracoscopic anatomical segmentectomy

Li, Shenghui; Wu, Junqi; Wan, Ziwei; Chen, Yingyao; She, Yunlang; Xie, Dong; Hu, Xuefei; Zhao, Deping; Chen, Chang

doi:10.1002/jso.26517

Cited by 13 publications

(12 citation statements)

References 30 publications

(71 reference statements)

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“…We believe that cumulative experience was not a significant confounding factor since the two groups were contemporary. Albeit the uniportal learning curve can have a negative effect on operating time and perioperative complications (22,23), we did not find a difference in perioperative outcomes. Furthermore, once the UVATS technique was adopted by the three uniportal surgeons, this approach was used exclusively thereafter which could explain the shorter operating time found in our series.…”

Section: Discussioncontrasting

confidence: 64%

Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study

Diaz-Gutierrez¹,

Menier²,

Savoie-White³

et al. 2023

J Thorac Dis

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Background: Uniportal video-assisted thoracoscopic surgery (VATS) segmentectomy is gaining worldwide acceptance, but experience in North America is still limited. We report a North American multicenter comparison of uniportal vs. multiportal VATS segmentectomy. Methods:We performed an institutional review board-exempt retrospective chart review on prospectively collected databases at two North American centers, from January 2012 to December 2020. We included all VATS segmentectomy patients and excluded emergent cases (n=1), patients with incomplete records (n=2), and segmentectomy performed in conjunction with another type of lung resection (n=1). We recorded patient demographics, perioperative data, 30-day postoperative complications and compared outcomes between cohorts. We provided descriptive statistics for each group. We calculated propensity score matching and paired patients 1:1. We defined P values less than 0.05 as statistically significant.Results: We performed a total of 423 VATS segmentectomies, 181 uniportal (42.7%) vs. 242 multiportal (57.2%). Indications for surgery were primary lung cancer (n=339), metastatic (n=41), benign disease (n=40), and other (n=3). We staged 85.1% of patients preoperatively with PET-CT scan according to National Comprehensive Cancer Network (NCCN) guidelines. Propensity score matching generated 156 patients on each group. Operating time was significantly lower in the uniportal group compared to multiportal (130 vs. 161 min respectively, P<0.001). We found no difference in estimated blood loss, Clavien-Dindo class III-IV complications, conversion to thoracotomy, R0 resection rate, nodal upstaging, hospital length of stay, 30-day readmission or mortality.Conclusions: Our experience from two North American centers indicates that, in experienced hands, postoperative outcomes after uniportal and multiportal VATS segmentectomy are comparable.

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Section: Discussioncontrasting

confidence: 64%

Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study

Diaz-Gutierrez¹,

Menier²,

Savoie-White³

et al. 2023

J Thorac Dis

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“…The question we addressed is how many complex segmentectomies are needed to reach proficiency. Several studies have explored the learning curve for VATS anatomical segmentectomy, encompassing multiport, two-port, and uniportal access techniques ( 12 - 15 ). Dimitrovska and her colleagues observed that the inflection point in the learning curve was reached after conducting 47 cases, with surgeons attaining proficiency after performing 57 cases ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Dimitrovska and her colleagues observed that the inflection point in the learning curve was reached after conducting 47 cases, with surgeons attaining proficiency after performing 57 cases ( 13 ). Li and colleagues determined that mastering uniportal VATS anatomical segmentectomy required approximately 64 to 71 cases, while achieving proficiency necessitated around 90 to 100 cases ( 12 ). However, research on the learning curve for uniportal VATS complex segmentectomy is relatively limited.…”

Section: Discussionmentioning

confidence: 99%

Learning curve for complex segmentectomy via uniportal video-assisted thoracoscopic surgery for the treatment of early-stage lung cancer

Ahn,

Moon

2024

J Thorac Dis

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Background Recently, segmentectomy has emerged as a viable treatment option for early-stage lung cancer. Segmentectomy can be divided into simple segmentectomy and complex segmentectomy. While simple segmentectomy is a relatively straightforward surgical procedure, complex segmentectomy poses a considerable challenge because of its intricate anatomical variations and the need for a complex surgical approach. The introduction of uniportal video-assisted thoracoscopic surgery (VATS) further complicates matters. This study aimed to assess whether thoracic surgeons, who have previously conducted only uniportal VATS lobectomy and simple segmentectomy, could effectively navigate the learning curve when undertaking their first complex segmentectomy procedure. Methods A single surgeon with experience limited to uniportal VATS lobectomy and simple segmentectomy began performing uniportal VATS complex segmentectomy in 2019, completing 167 cases of complex segmentectomy during the same period and performing 70 cases of simple segmentectomy. We analyzed the learning curve by comparing the surgical outcomes and operative time curves between simple segmentectomy and complex segmentectomy. Results The complex segmentectomy group exhibited similarities with the simple segmentectomy group in terms of patient and tumor characteristics, operative outcomes, and postoperative outcomes, with the exception of the complex segmentectomy group showing slightly reduced chest tube drainage and shorter hospital stays. The operative times and time curve patterns showed no significant difference between the two groups, indicating a potential lack of a distinct learning curve for complex segmentectomy. Conclusions Complex segmentectomy via uniportal VATS, when performed by surgeons proficient in simple segmentectomy and lobectomy techniques, has comparable outcomes and potentially eliminates the need for an extensive learning curve. This approach expands the options for treating early-stage non-small-cell lung cancer (NSCLC), allowing for tailored patient care. Further studies are needed to assess long-term outcomes.

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“…So far, studies have been carried out in large-volume centers to analyze the learning curve of U-VATS lobectomy regardless of video review (Table 2) (7,(18)(19)(20). According to the results of these study, about 57-140 cases are needed to attain the proficient phase.…”

Section: Discussionmentioning

confidence: 99%

The learning curve on uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos

Song

Cheng

et al. 2023

Front. Oncol.

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ObjectivesVideo-assisted thoracoscopic lobectomy has become the preferred surgical approach in experienced centers, and uniportal approaches are becoming increasingly used. But the uniportal approach is still not widely applied presumably due to the learning difficulties of this complex procedure. The use of surgical videos may be helpful to accelerate the learning of this new techniques as in other fields. In this study, we aimed to analyze the learning curve of uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos.Methods114 patients with early-stage lung cancer who underwent uniportal video-assisted thoracoscopic lobectomy performed from 2020 to 2021 were reviewed in this study. We recorded the operation video for each patient and reviewed all the videos after surgery. The learning curves were assessed using cumulative sum analysis and the collected data of perioperative outcomes were assessed.ResultsThe CUMSUM curve showed its inflection points were around case 38 and 53. It was less compared with previous studies, which about 57–140 cases are needed to attain the proficient phase. The perioperative outcomes were similar in each phase, which included intraoperative blood loss (79.00 ± 26.70 vs 70.67 ± 26.64 vs 70.56 ± 27.23, p=0.0119), the length of hospital stay (3.60 ± 1.52 days vs. 3.23 ± 0.90 days vs. 3.06 ± 0.88 days, p=0.053), the rate of prolonged air leak and conversion to open thoracotomy. There was also no significant difference in the numbers and station of lymph node dissection among the three phases.ConclusionsUniportal video-assisted thoracoscopic lobectomy is a safe and reliable approach. Recording and reviewing the operation video could help the surgeon to improve deficiencies and refine the procedure.

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The learning curve for uniportal video‐assisted thoracoscopic anatomical segmentectomy

Cited by 13 publications

References 30 publications

Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study

Uniportal vs. multiportal thoracoscopic segmentectomy: a north American study

Learning curve for complex segmentectomy via uniportal video-assisted thoracoscopic surgery for the treatment of early-stage lung cancer

The learning curve on uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos

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