Learning Curve for Thoracoscopic Individual Basilar Segmentectomy: 18-Year Experience

Area of Science:

• Thoracic Surgery
• Surgical Innovation
• Minimally Invasive Procedures

Background:

• Thoracoscopic anatomical individual basilar segmentectomy presents significant challenges due to deep hilar structures and anatomical variations.
• This study analyzes the experience and progress in performing these complex procedures at a university hospital.

Purpose of the Study:

• To evaluate the learning curve and progression of thoracoscopic anatomical individual basilar segmentectomy.
• To assess the impact of experience on surgical outcomes and efficiency.

Main Methods:

• Retrospective analysis of 127 patients undergoing anatomical basilar segmentectomy between 2004 and 2021.
• Division of the study period into an introductory (2004-2012) and a maturity (2013-2021) phase of video-assisted thoracoscopic surgery (VATS) segmentectomy.
• Evaluation of the surgeon's learning curve using operative time and cumulative sum analysis during the maturity period.

Main Results:

• The maturity period (2013-2021) saw higher patient age and comorbidity index but shorter postoperative hospitalization and operative times compared to the introductory period (2004-2012).
• Increased use of uniport procedures was observed in the later period.
• The learning curve analysis indicated that the inflection point for thoracoscopic basilar segmentectomy was reached after 42 cases.

Conclusions:

• A single institution demonstrated significant progress in performing difficult thoracoscopic segmentectomies.
• The identified learning curve provides valuable insights for other institutions considering this advanced surgical technique.