Learning Curve for Uniportal Thoracoscopic Anatomical Pulmonary Segmentectomy

Area of Science:

• Thoracic Surgery
• Minimally Invasive Surgery
• Surgical Education

Background:

• Video-assisted thoracoscopic segmentectomy is effective for select patients.
• Uniportal thoracoscopic segmentectomy presents significant technical challenges.
• Understanding the learning curve is crucial for surgeon proficiency.

Purpose of the Study:

• To investigate the learning curve associated with uniportal thoracoscopic segmentectomy.
• To identify phases of skill acquisition in this surgical technique.

Main Methods:

• Retrospective analysis of 124 consecutive uniportal thoracoscopic segmentectomy cases (August 2016 - September 2018).
• Utilized cumulative sum (CUSUM) and risk-adjusted cumulative sum (RA-CUSUM) methods to analyze the learning curve.
• Identified distinct learning phases based on statistical analysis.

Main Results:

• The learning curve demonstrated three distinct phases: cases 1-24, 25-57, and 58-124.
• Operation time progressively decreased as surgical experience increased.
• The learning curve's inflection point, indicating proficiency, was reached around the 57th case.

Conclusions:

• Uniportal thoracoscopic segmentectomy is a feasible and safe procedure.
• The technique can be effectively taught through a structured, proctored learning curve.
• Mastery of uniportal thoracoscopic segmentectomy requires approximately 57 cases for surgeons to complete the learning curve.