Learning Curve for Port-access Thoracoscopic Anatomic Lung Segmentectomy

Objectives: There have been few prospective randomized studies, but many retrospective studies strongly suggest the benefits of segmentectomy in properly selected patients. The indications for video-assisted thoracic surgery segmentectomy are growing because of the effectiveness and minimal invasiveness of the procedure. The aim of the present study was to analyze the learning curve for video-assisted thoracic surgery segmentectomy procedures in our institution.

Methods: We prospectively collected data from patients undergoing video-assisted thoracic surgery segmentectomy and retrospectively reviewed 252 patients from 2004 to 2015. Operative time, bleeding, and complications were analyzed. The learning curve was evaluated using operative time and the cumulative sum value of operative time in all cases with regard to the leading surgeon and nonleading surgeon at our institution.

Results: Once we applied the cumulative sum method to all cases, we obtained a graph for the cumulative sum value of operative time that showed 3 well-differentiated phases: phase 1 (n = 61), the initial learning phase; phase 2 (n = 23), the increased competence phase; and phase 3 (n = 168), the highest skill phase. As we compared phases 1 and 2 with phase 3, we observed significant differences in relation to operative time (P < .001) and bleeding (P < .001). Without level 3 segmentectomy, we observed a significant reduction in operative time after 32 cases for the leading surgeon and a significant reduction in operative time and bleeding after 38 cases for the nonleading surgeon.

Conclusions: The data suggest that the inflection point for the learning curve was achieved after 84 cases in our institution. Therefore, increased aptitude with video-assisted thoracic surgery is achievable within a relatively short time.