Perioperative surgical outcomes and learning curves of thoracoscopic basal segmentectomy

Pulmonary basal segmentectomy is more technically demanding than other segmental resections because of its anatomical complexity and frequent variations in vascular and bronchial structures. The purpose of this study was to explore the factors that affect operation time, postoperative complications and surgical costs during basal segment resection to provide reference value for clinical practice.

This study retrospectively enrolled 190 patients who underwent thoracoscopic single or combined basal segmentectomy at the Department of Thoracic Surgery of China-Japan Friendship Hospital. Basic clinical information and perioperative data were collected, and Spearman correlation analysis and non-parametric Mann-Whitney U test and multiple linear regression were performed to identify potential influencing factors. The learning curve was evaluated based on the operative time and the cumulative sum value of the operative time in all patients.

Among the 190 patients, 70 patients underwent segment resection excluding S9/S10, and 120 patients underwent segmentectomy including S9/S10. The mean operative time was 2.18±0.76 hours, the average duration of chest drainage was 3.24 days, and the mean postoperative hospitalization time was 4.24 days. The final multiple linear regression analysis results show that surgical approach, surgical procedure and intraoperative bleeding will significantly affect the operation time, surgical procedure will significantly affect the total hospitalization cost, and poor development of lung fissure will prolong the postoperative tube time. In 119 cases, the surgeon was just beginning to perform segmentectomy; after 119 cases, the surgeon became quite proficient. Thus, surgery becomes more efficient.

The surgical choice of single-hole thoracoscopy may significantly shorten the operation time, and the intraoperative bleeding will significantly increase the total operation time. The operation time with S9/S10 is longer than that without S9 and S10, and the total cost of hospitalization is higher. The development of pulmonary fissures significantly reduces the possibility of postoperative lung leakage.