Video-assisted thoracoscopic lobectomy: which is the learning curve of an experienced consultant?

• DOI: 10.21037/jtd.2016.08.23
• Publication Date: 2016-09-27T22:45:32Z
• Authors: Antonio Mazzella; Anne Olland; Pierre Emmanuel F...; Stephane Renaud; Nicola Santelmo; Gilbert Massard
• Keywords: Learning curve; VATS lobectomy; Video-assisted thoracoscopic surgery

This study evaluates the number of video-assisted thoracic surgery-lobectomies (VATS-lobectomies) required for an experienced consultant surgeon to obtain competence and perform standard quality surgery.We have analysed initial VATS-experience (January 2012 September 2014) a confirmed senior who has performed 145 consecutive anatomic resections by thoracoscopy. After excluding bilobectomies, segmentectomies, lobectomies infectious disease, we focused into 119 lobectomies, classified 4 chronologic groups 30 each. We considered: demographics; pathology; postoperative outcomes; conversion rate; morbidity. compared in Bayesian inference model (very strong probability difference if Pr>95% or <5%; 95%>Pr>80% 5%<Pr<20%).There was very group 1 (first lobectomies) 3 other groups: less incomplete fissures (Pr1<2=0.019, Pr1<3=0.037, Pr1<4=0.046), more node samplings (Pr1>2=0.977, Pr1>3=0.96, Pr1>4=0.997) and, conversely, radical dissections (Pr1<2=0.022, Pr1<3=0.039, Pr1<4=0.003), harvested nodes (Pr1<2≤0.001, Pr1<3≤0.001, Pr1<4≤0.001), pleural adhesions (Pr1<2=0.077, Pr1<3=0.044). Instead, there first three 90 lobectomies): lower rate (Pr1>4=0.992, Pr3>4=0.996, Pr2>4=0.995), duration operation (Pr1>4=0.946, Pr2>4=0.901, Pr3>4=0.932), air leak (Pr1>4=0.936, Pr2>4=0.97) shorter chest tube drainage (Pr1>4=0.94, Pr2>4=0.94, Pr3>4=0.937), as well hospital stay (Pr2>4=0.94, Pr3>4=0.937).The learning curve bimodal. oncologic procedure improved stabilized. The became selective accepted proceed with complex cases (incomplete fissures, adhesions). Efficiency obtained after (shorter operative time rate).