Learning curve of totally thoracoscopic pulmonary segmentectomy

Abstract

Totally thoracoscopic pulmonary segmentectomy (TTPS) is a feasible and safe technique that requires advanced thoracoscopic skills and knowledge of pulmonary anatomy. However, data describing the learning curve of TTPS have yet to be obtained. In this study, 128 patients who underwent TTPS between September 2010 and December 2013 were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, namely, ascending phase (A), plateau phase (B), and descending phase (C), through cumulative summation (CUSUM) for operative time (OT). Phases A, B, and C comprised 39, 33, and 56 cases, respectively. OT and blood loss decreased significantly from phases A to C (P <0.01), and the frequency of intraoperative bronchoscopy for target bronchus identification decreased gradually (A, 8/39; B, 4/33; C, 3/56; P = 0.06). No significant differences were observed in demographic factors, conversion, complications, hospital stay, and retrieved lymph nodes among the three phases. Surgical outcomes and techniques improved with experience and volume. CUSUM_OT indicated that the learning curve of TTPS should be more than 72 cases.

Keywords

thoracoscopic / segmentectomy / learning curve / CUSUM

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 81572263), Natural Science Foundation of Jiangsu Province (No. BK20151584), Jiangsu Top Expert Program in Six Professions (No. WSW-028), Major Program of Science and Technology Foundation of Jiangsu Province (No. BE2016790), Jiangsu Medical Young Talent Project (No. QNRC2016566), the Program of Jiangsu Medical Innovation Team (No. CXTDA2017006), and Jiangsu Province 333 Talents Project (No. BRA2017545).

Compliance with ethics guidelines

Weibing Wu, Jing Xu, Wei Wen, Yue Yu, Xinfeng Xu, Quan Zhu, and Liang Chen declare that they have no conflict of interest. All procedures were in accordance with the ethical standards of the responsible committee on human experimentation (Nanjing Medical University Institutional Review Board) and with the Declaration of Helsinki of 1975 revised in 2000.

Electronic Supplementary Material Supplementary material is available in the online version of this article at https://doi.org/10.1007/s11684-017-0566-z and is accessible for authorized users.

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