Learning Curve of Totally Thoracoscopic Pulmonary Segmentectomy

Overview

Journal Front Med

Specialty General Medicine

Date 2018 Feb 10

PMID 29423884

Citations 3

Authors

Weibing Wu

Jing Xu

Wei Wen

Yue Yu

Xinfeng Xu

Quan Zhu

Liang Chen

Affiliations

Soon will be listed here.

Abstract

Totally thoracoscopic pulmonary segmentectomy (TTPS) is a feasible and safe technique that requires advanced thoracoscopic skills and knowledge of pulmonary anatomy. However, data describing the learning curve of TTPS have yet to be obtained. In this study, 128 patients who underwent TTPS between September 2010 and December 2013 were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, namely, ascending phase (A), plateau phase (B), and descending phase (C), through cumulative summation (CUSUM) for operative time (OT). Phases A, B, and C comprised 39, 33, and 56 cases, respectively. OT and blood loss decreased significantly from phases A to C (P < 0.01), and the frequency of intraoperative bronchoscopy for target bronchus identification decreased gradually (A, 8/39; B, 4/33; C, 3/56; P = 0.06). No significant differences were observed in demographic factors, conversion, complications, hospital stay, and retrieved lymph nodes among the three phases. Surgical outcomes and techniques improved with experience and volume. CUSUMOT indicated that the learning curve of TTPS should be more than 72 cases.

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References

Mawatari T, Murakami G, Koshino T, Morishita K, Abe T . Posterior pulmonary lobe: segmental and vascular anatomy in human specimens. Clin Anat. 2000; 13(4):257-62. DOI: 10.1002/1098-2353(2000)13:4<257::AID-CA5>3.0.CO;2-5. View

Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A . Effect of tumor size on prognosis in patients with non-small cell lung cancer: the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg. 2005; 129(1):87-93. DOI: 10.1016/j.jtcvs.2004.04.030. View

Williams S, Parry B, Schlup M . Quality control: an application of the cusum. BMJ. 1992; 304(6838):1359-61. PMC: 1882013. DOI: 10.1136/bmj.304.6838.1359. View

Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N . Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg. 2005; 80(6):2041-5. DOI: 10.1016/j.athoracsur.2005.06.010. View

CHURCHILL E, BELSEY R . SEGMENTAL PNEUMONECTOMY IN BRONCHIECTASIS: THE LINGULA SEGMENT OF THE LEFT UPPER LOBE. Ann Surg. 1939; 109(4):481-99. PMC: 1391296. DOI: 10.1097/00000658-193904000-00001. View

Atkins B, Harpole Jr D, Mangum J, Toloza E, DAmico T, Burfeind Jr W . Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimally-invasive approach. Ann Thorac Surg. 2007; 84(4):1107-12. DOI: 10.1016/j.athoracsur.2007.05.013. View

McKenna Jr R . Complications and learning curves for video-assisted thoracic surgery lobectomy. Thorac Surg Clin. 2008; 18(3):275-80. DOI: 10.1016/j.thorsurg.2008.04.004. View

Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y . Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg. 2009; 35(5):775-80. DOI: 10.1016/j.ejcts.2009.01.013. View

Oizumi H, Kanauchi N, Kato H, Endoh M, Takeda S, Suzuki J . Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg. 2009; 36(2):374-7. DOI: 10.1016/j.ejcts.2009.03.038. View

10.

Schuchert M, Pettiford B, Pennathur A, Abbas G, Awais O, Close J . Anatomic segmentectomy for stage I non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg. 2009; 138(6):1318-25.e1. DOI: 10.1016/j.jtcvs.2009.08.028. View

11.

Wisnivesky J, Henschke C, Swanson S, Yankelevitz D, Zulueta J, Marcus S . Limited resection for the treatment of patients with stage IA lung cancer. Ann Surg. 2010; 251(3):550-4. DOI: 10.1097/SLA.0b013e3181c0e5f3. View

12.

Leshnower B, Miller D, Fernandez F, Pickens A, Force S . Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg. 2010; 89(5):1571-6. DOI: 10.1016/j.athoracsur.2010.01.061. View

13.

Zhao H, Bu L, Yang F, Li J, Li Y, Wang J . Video-assisted thoracoscopic surgery lobectomy for lung cancer: the learning curve. World J Surg. 2010; 34(10):2368-72. DOI: 10.1007/s00268-010-0661-7. View

14.

Yoshimoto K, Nomori H, Mori T, Ohba Y, Shibata H, Tashiro K . A segmentectomy of the right upper lobe has an advantage over a right upper lobectomy regarding the preservation of the functional volume of the right middle lobe: analysis by perfusion single-photon emission computed tomography/computed tomography. Surg Today. 2010; 40(7):614-9. DOI: 10.1007/s00595-009-4103-9. View

15.

Bokhari M, Patel C, Ramos-Valadez D, Ragupathi M, Haas E . Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc. 2010; 25(3):855-60. PMC: 3044842. DOI: 10.1007/s00464-010-1281-x. View

16.

Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Fukaya K . Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg. 2010; 141(3):678-82. DOI: 10.1016/j.jtcvs.2010.08.027. View

17.

Gossot D, Ramos R, Brian E, Raynaud C, Girard P, Strauss C . A totally thoracoscopic approach for pulmonary anatomic segmentectomies. Interact Cardiovasc Thorac Surg. 2011; 12(4):529-32. DOI: 10.1510/icvts.2010.257493. View

18.

Yamashita S, Tokuishi K, Anami K, Moroga T, Miyawaki M, Chujo M . Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg. 2012; 42(1):83-8. DOI: 10.1093/ejcts/ezr254. View

19.

Schuchert M, Abbas G, Awais O, Pennathur A, Nason K, Wilson D . Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer. Ann Thorac Surg. 2012; 93(6):1780-5. DOI: 10.1016/j.athoracsur.2011.11.074. View

20.

Yang C, DAmico T . Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg. 2012; 94(2):668-81. DOI: 10.1016/j.athoracsur.2012.03.080. View