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Minerva Surgery 2022 April;77(2):101-8

DOI: 10.23736/S2724-5691.21.08895-X


lingua: Inglese

Learning curve for completely thoracoscopic anatomic sublobar resection

George RAKOVICH 1 , Ghizlane BELAHMIRA 1, William H. WOODALL 2, Jeremie BERDUGO 3

1 Unit of Thoracic Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada; 2 Department of Statistics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA; 3 Department of Pathology, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada

BACKGROUND: Minimally invasive anatomic sublobar resection is increasingly being considered as an alternative to lobectomy in selected cases. However, this remains a technically challenging procedure and only 5 studies evaluating learning curves have been published to date. The aim of this study was to evaluate a single surgeon’s learning curve for completely thoracoscopic anatomic sublobar resection.
METHODS: A retrospective review was conducted of all thoracoscopic anatomic sublobar resections by one surgeon proficient in VATS lobectomy between January 2015 and January 2020. The primary outcome was operative time. Secondary outcomes were perioperative complications, duration of chest tube drainage and length of stay.
RESULTS: There were 67 thoracoscopic anatomic sublobar resections performed in 66 patients. A Time-series plot and Cumulative Sum analysis of operative times showed a drop off after case 32, suggesting achievement of competency. After case 32, mean operative times were decreased (128.59±32.42 min. vs. 153.63±40.16 min, P=0.013) and there was a trend toward decreased blood loss (124.26±76.0 vs. 175.0±141.99 mL, P=0.073). A percentage 13.6% of patients had postoperative complications other than air leak and 88,9% of these were Clavien-Dindo class 1-2; postoperative complications were evenly distributed before and after case 32. Cumlulative Sum curves for the duration of chest tube drainage and length of stay did not show any significant change during the study period.
CONCLUSIONS: This study suggests that for a surgeon proficient in VATS lobectomy, competency in completely thoracoscopic anatomic sublobar resection can be achieved after 32 cases and can be accomplished in a way that does not compromise perioperative outcomes.

KEY WORDS: Pulmonary surgical procedures; Thoracic surgery, video-assisted; Motor skills; Lung neoplasms

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