Supervision by an experienced surgeon can reduce the learning curve of uniportal thoracoscopic lobectomy

This retrospective study was performed to investigate the learning curve of uniportal thoracoscopic lobectomy with ND2a-1 or greater lymphadenectomy for two senior surgeons, and to evaluate how supervision affected the learning curve.

Between February 2019 and January 2022, 140 patients with primary lung cancer underwent uniportal thoracoscopic lobectomy with ND2a-1 or greater lymphadenectomy in our department. Two senior surgeons (HI and NM) performed most of the operations, with junior surgeons performing the rest. HI initiated this surgical method in our department and supervised all operations performed by other surgeons. Patient characteristics and perioperative outcomes were reviewed, and the learning curve was evaluated based on operative time and the cumulative sum method (CUSUM_OT).

No significant differences were observed in patient characteristics or perioperative outcomes between groups. Three distinct learning curve phases were identified for each senior surgeon: HI, cases 1-21, cases 22-40, cases 41-71; NM cases 1-16, cases 17-30, cases 31-49. For HI, the rate of conversion to thoracotomy was significantly higher in the initial phase (14.3%, P=0.04) although other perioperative outcomes were equivalent between phases. For NM, while the duration of postoperative drainage was significantly shorter in phase 2 and phase 3 (P=0.026), other perioperative outcomes, including conversion rate (5.3-7.1%), were equivalent between phases.

Supervision by an experienced surgeon was important for avoiding conversion to thoracotomy during the initial period, and facilitated the surgeon rapidly gaining proficiency with the surgical method.