Safety and efficiency of supervised sequentially overlapping video-assisted thoracoscopic lobectomies in a...

Low-dose computed tomography (CT) screening has increased early-stage lung cancer detection, leading to a higher demand for video-assisted thoracoscopic surgery (VATS) lobectomy. Overlapping surgeries optimize resources but raise safety concerns. This study evaluates the safety and efficiency of overlapping VATS lobectomies in a high-volume center.

We conducted a retrospective cohort study of patients undergoing VATS lobectomy at Shanghai Pulmonary Hospital, Tongji University between 2019 and 2021. Overlapping surgeries, defined as the principal surgeon involved in 2 simultaneous procedures, were stratified by percentage of overlap duration: <50% or ≥50%. Nonoverlapping cases served as the control group. Coarsened exact matching (CEM) was applied to adjust for confounders. The primary outcome was major complications (Clavien-Dindo grade III-IV). Secondary outcomes included 90-day mortality, minor complications, unplanned readmission, hospital length of stay, and intraoperative events.

Among 14,352 patients, overlapping cases involved greater preoperative workload (median, 221 minutes vs 85 minutes; P < .001) and later operative start times (P < .001). After CEM, 3216 matched pairs showed no significant differences in major complications, mortality, readmissions, prolonged hospital stay, or minor complications. Intraoperative events (ie, operative time, bleeding, and conversion) showed only small statistical differences without clinical significance. Subgroup analyses confirmed similar outcomes regardless of overlap duration.

When appropriately supervised, overlapping VATS lobectomies are safe, with outcomes unaffected by even ≥50% overlap, thus optimizing efficiency in high-volume centers. This practice enhances surgical efficiency in high-volume centers without compromising patient safety.