Uniportal video-assisted thoracoscopic surgery for lobectomy: the learning curve.

Abstract

Prior reported learning curves for uniportal video-assisted thoracoscopic lobectomy were predominantly based on surgery duration, whilst reports on complications are limited. Therefore, our study assessed the learning curve based on both technique-related complications and surgery duration. We retrospectively collected data from patients who underwent uniportal video-assisted thoracoscopic lobectomy, between 2015 and 2020. Exclusion criteria were concomitant procedures other than ipsilateral wedge resection, discontinued procedures, or lost to follow-up (<30 days). Learning curves were constructed per surgeon who performed over 20 procedures using non-risk adjusted cumulative sum analysis for technique-related complications and cumulative sum analysis for surgery duration. Based on the literature, an acceptable complication rate was set at 30%, an unacceptable complication rate at 45%, and a mean surgery duration of 145 minutes. Learning curves were constructed for three thoracic surgeons and one fellow who performed 324 uniportal video-assisted thoracoscopic lobectomies in total. Each surgeon was experienced in multiportal video-assisted thoracoscopic lobectomy, the fellow was familiar with basic multiportal video-assisted thoracoscopic procedures. Cumulative sum charts of three surgeons reached a statistically significant technique-related complication rate below 30% between 50 to 96 procedures. Regarding surgery duration, typical learning curves were observed for three surgeons with a transition point between 14 to 26 procedures. Learning of uniportal video-assisted thoracoscopic surgery for lobectomy is safe without unacceptable complication rates and has a declining surgery duration over time for thoracic surgeons with experience in multiportal video-assisted thoracoscopic lobectomies. However, it remains unknown when the different stages of mastery are completed.