Competence versus mastery: the time course for developing proficiency in video-assisted thoracoscopic lobectomy

Area of Science:

• Thoracic surgery
• Minimally invasive procedures
• Surgical education

Background:

• The learning curve for thoracoscopic lobectomy is not well-defined.
• Proficiency development in this surgical technique requires further evaluation.
• Experienced open surgeons were studied to understand thoracoscopic lobectomy learning curves.

Purpose of the Study:

• To compare learning curves for two surgeons experienced in open lobectomy.
• To define the learning process for thoracoscopic lobectomy.
• To evaluate elements of proficiency including efficiency and consistency.

Main Methods:

• Analysis of the first 200 thoracoscopic lobectomy cases for two surgeons.
• Evaluation of operative time, blood loss, and length of stay using Change-Point Analysis and moving averages.
• Assessment of conversion to open rates and complication rates.

Main Results:

• Operative time efficiency was achieved between 108 and 157 cases; blood loss efficiency between 126 and 139 cases.
• Conversion to open rates decreased significantly over the study period.
• Consistency in operative time and blood loss was not reliably achieved; length of stay and complication rates remained stable.

Conclusions:

• Learning curves for video-assisted thoracoscopic lobectomy were similar for both surgeons.
• Efficiency in thoracoscopic lobectomy typically requires 100–200 cases.
• Achieving consistency in surgical outcomes necessitates more than 200 cases.