Reasons for conversion during VATS lobectomy: what happens with increased experience

Area of Science:

• Thoracic Surgery
• Minimally Invasive Procedures
• Surgical Complications

Background:

• Video-assisted thoracic surgery (VATS) lobectomy offers benefits over thoracotomy but carries risks of intraoperative conversion to open surgery.
• Existing literature classifies reasons for conversion, but the impact of surgical experience on these reasons requires further investigation.

Purpose of the Study:

• To evaluate how the reasons for intraoperative conversion to thoracotomy during VATS lobectomy change with increasing surgeon experience.
• To compare conversion rates and causes between a learning curve (LC) group and an after learning curve (ALC) group.

Main Methods:

• Single-center retrospective review of VATS lobectomy cases between 2011 and 2017.
• Patients converted to thoracotomy were divided into LC (learning curve) and ALC (after learning curve) groups.
• Analysis of reasons for conversion in both groups.

Main Results:

• The overall conversion rate decreased with increased surgical experience.
• Calcified, benign, or malignant hilar adenopathy was the most frequent reason for conversion in both groups.
• Complicated vascular dissection or vessel injury due to hilar adenopathy was the leading cause of conversion.

Conclusions:

• While increased experience in VATS lobectomy reduces conversion rates, complex hilar adenopathy remains a significant challenge.
• Development of advanced management strategies and techniques is crucial to prevent and manage intraoperative adverse events related to hilar dissection.
• Continued focus on refining VATS techniques is necessary to further minimize conversions and improve patient outcomes.