Learning Curve for Uniportal Thoracoscopic Anatomical Pulmonary Segmentectomy

Background. Video-assisted thoracoscopic segmentectomy has been considered to be an effective management in properly selected patients. Given the substantial technical difficulties, uniportal thoracoscopic segmentectomy is a challenging surgical procedure. The purpose of this study was to investigate the learning curve for uniportal thoracoscopic segmentectomy procedures. Methods. Prospectively collected data were retrospectively analyzed for a series of 124 consecutive patients undergoing uniportal thoracoscopic segmentectomy from August 2016 to September 2018. The learning curve for uniportal thoracoscopic segmentectomy was studied using cumulative sum (CUSUM) combined with risk-adjusted cumulative sum (RA-CUSUM) methods. Results. According to the CUSUM combined with the RA-CUSUM analyses, the learning curve for uniportal thoracoscopic segmentectomy was composed of three well-differentiated phases: cases 1 to 24, cases 25 to 57, and cases 58 to 124. With the procedures proceeded orderly, the operation time tends to progressively decrease. Conclusions. The uniportal thoracoscopic segmentectomy is considered to be a feasible and safe surgical procedure that can be taught to surgeons through a proctored learning curve. The data of the present study indicate that the inflection point for completion the learning curve was reached after a considerable number of 57 cases.