Learning curve for two-port video-assisted thoracoscopic surgery lung segmentectomy

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Procedures

Background:

• Segmentectomy is a lung-sparing surgical option for early-stage lung cancer.
• Two-port video-assisted thoracoscopic surgery (VATS) segmentectomy is a minimally invasive technique.
• Understanding the surgeon's learning curve is crucial for optimizing VATS segmentectomy outcomes.

Purpose of the Study:

• To analyze the learning curve for two-port VATS segmentectomy.
• To identify distinct phases of surgical proficiency.
• To determine the number of cases required to achieve surgical expertise.

Main Methods:

• Retrospective analysis of 86 patients undergoing two-port VATS segmentectomy.
• Evaluation of operative time (OT) and estimated blood loss.
• Cumulative sum (CUSUM) analysis of OTs to assess the learning curve.

Main Results:

• The learning curve was divided into three phases: initial learning (1-27), increased competence (28-54), and experienced (55-86).
• The CUSUM inflection point, indicating mastery, was observed around the 47th case.
• Significant reductions in OT and bleeding were noted in the experienced phase compared to earlier phases.

Conclusions:

• CUSUM analysis effectively delineates the learning curve stages for two-port VATS segmentectomy.
• Surgical proficiency, marked by reduced operative time and blood loss, is achieved after approximately 47 cases.
• This study provides a benchmark for surgeon training and quality assessment in VATS segmentectomy.