The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspective
Objectives: To evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of video-assisted thoracoscopic sleeve lobectomy. Methods: We reviewed 127 cases of video-assisted thoracoscopic sleeve lobectomy by a single surgeon at Shanghai Pulmonary Hospital to...
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Elsevier
2021-10-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250721004764 |
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| author | Jiajun Deng, MD Lei Jiang, MD Shenghui Li, MD Lei Zhang, MD Yifan Zhong, MD Dong Xie, MD, PhD Chang Chen, MD, PhD |
| author_facet | Jiajun Deng, MD Lei Jiang, MD Shenghui Li, MD Lei Zhang, MD Yifan Zhong, MD Dong Xie, MD, PhD Chang Chen, MD, PhD |
| author_sort | Jiajun Deng, MD |
| collection | DOAJ |
| description | Objectives: To evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of video-assisted thoracoscopic sleeve lobectomy. Methods: We reviewed 127 cases of video-assisted thoracoscopic sleeve lobectomy by a single surgeon at Shanghai Pulmonary Hospital to evaluate its learning curve using the cumulative sum (CUSUM) analysis. The changes of perioperative outcomes were assessed. Results: The inflection points of the CUSUM curve were around case 30 and 90, according to which 3 phases were identified: Phase I, Phase II, and Phase III. Significant downtrends were observed regarding operative time (Phase I, 194 [173-233 minutes] vs Phase II, 172 [142-215 minutes] vs Phase III, 138 [117-164 minutes], P < .05, all), blood loss (Phase I, 200 [100-238 mL] vs Phase II, 100 [50-200 mL] vs Phase III, 50 [50-100 mL]; P < .05, all), drainage duration (Phase I [5.53 ± 1.11 days] vs Phase II [4.52 ± 1.38 days]; P < .05), and length of postoperative stays (Phase I [6.60 ± 1.13 days] vs Phase II [5.68 ± 1.47 days], P < .05). The rate of severe complications significantly decreased from Phase I to Phase II (P = .03). Conclusions: Thirty cases should be accumulated to lay the technical foundation, and 90 cases were required to achieve proficiency. The focus should now shift to providing sufficient training opportunities for centers wanting to implement this technique. |
| format | Article |
| id | doaj-art-4d969ed33f6f4e6797fb73db00c2c423 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-4d969ed33f6f4e6797fb73db00c2c4232025-08-20T03:38:25ZengElsevierJTCVS Techniques2666-25072021-10-01914315210.1016/j.xjtc.2021.07.006The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspectiveJiajun Deng, MD0Lei Jiang, MD1Shenghui Li, MD2Lei Zhang, MD3Yifan Zhong, MD4Dong Xie, MD, PhD5Chang Chen, MD, PhD6Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, ChinaDepartment of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, ChinaAddress for reprints: Chang Chen, MD, PhD, and Dong Xie, MD, PhD, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200443, China.; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, ChinaObjectives: To evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of video-assisted thoracoscopic sleeve lobectomy. Methods: We reviewed 127 cases of video-assisted thoracoscopic sleeve lobectomy by a single surgeon at Shanghai Pulmonary Hospital to evaluate its learning curve using the cumulative sum (CUSUM) analysis. The changes of perioperative outcomes were assessed. Results: The inflection points of the CUSUM curve were around case 30 and 90, according to which 3 phases were identified: Phase I, Phase II, and Phase III. Significant downtrends were observed regarding operative time (Phase I, 194 [173-233 minutes] vs Phase II, 172 [142-215 minutes] vs Phase III, 138 [117-164 minutes], P < .05, all), blood loss (Phase I, 200 [100-238 mL] vs Phase II, 100 [50-200 mL] vs Phase III, 50 [50-100 mL]; P < .05, all), drainage duration (Phase I [5.53 ± 1.11 days] vs Phase II [4.52 ± 1.38 days]; P < .05), and length of postoperative stays (Phase I [6.60 ± 1.13 days] vs Phase II [5.68 ± 1.47 days], P < .05). The rate of severe complications significantly decreased from Phase I to Phase II (P = .03). Conclusions: Thirty cases should be accumulated to lay the technical foundation, and 90 cases were required to achieve proficiency. The focus should now shift to providing sufficient training opportunities for centers wanting to implement this technique.http://www.sciencedirect.com/science/article/pii/S2666250721004764video-assisted thoracoscopic surgerysleeve lobectomylearning curveperioperative outcomes |
| spellingShingle | Jiajun Deng, MD Lei Jiang, MD Shenghui Li, MD Lei Zhang, MD Yifan Zhong, MD Dong Xie, MD, PhD Chang Chen, MD, PhD The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspective JTCVS Techniques video-assisted thoracoscopic surgery sleeve lobectomy learning curve perioperative outcomes |
| title | The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspective |
| title_full | The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspective |
| title_fullStr | The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspective |
| title_full_unstemmed | The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspective |
| title_short | The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary centerCentral MessagePerspective |
| title_sort | learning curve of video assisted thoracoscopic sleeve lobectomy in a high volume pulmonary centercentral messageperspective |
| topic | video-assisted thoracoscopic surgery sleeve lobectomy learning curve perioperative outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2666250721004764 |
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