Advertisement

Learning curve of totally thoracoscopic pulmonary segmentectomy

  • Weibing Wu
  • Jing Xu
  • Wei Wen
  • Yue Yu
  • Xinfeng Xu
  • Quan Zhu
  • Liang Chen
Letter to Frontiers of Medicine
  • 15 Downloads

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. CUSUMOT indicated that the learning curve of TTPS should be more than 72 cases.

Keywords

thoracoscopic segmentectomy learning curve CUSUM 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

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).

Supplementary material

11684_2017_566_MOESM1_ESM.pdf (242 kb)
Supplementary Material

References

  1. 1.
    Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis: the lingual segment of the left upper lobe. Ann Surg 1939; 109 (4): 481–499CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Schuchert MJ, Abbas G, Awais O, Pennathur A, Nason KS, Wilson DO, Siegfried JM, Luketich JD, Landreneau RJ. Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer. Ann Thorac Surg 2012; 93(6): 1780–1787, discussion 1786–1787CrossRefPubMedGoogle Scholar
  3. 3.
    Landreneau RJ, Normolle DP, Christie NA, Awais O, Wizorek JJ, Abbas G, Pennathur A, Shende M, Weksler B, Luketich JD, Schuchert MJ. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol 2014; 32 (23): 2449–2455CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Effect of tumor size on prognosis in patients with nonsmall cell lung cancer: the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg 2005; 129(1): 87–93CrossRefPubMedGoogle Scholar
  5. 5.
    Yamashita S, Tokuishi K, Anami K, Moroga T, Miyawaki M, Chujo M, Yamamoto S, Kawahara K. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg 2012; 42(1): 83–88CrossRefPubMedGoogle Scholar
  6. 6.
    Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg 2005; 80(6): 2041–2045CrossRefPubMedGoogle Scholar
  7. 7.
    Yoshimoto K, Nomori H, Mori T, Ohba Y, Shibata H, Tashiro K, Shiraishi S, Kobayashi T. A segmentectomy of the right upper lobe has an advantage over a right upper lobectomy regarding the preservation of the functional volume of the right middle lobe: analysis by perfusion single-photon emission computed tomography/computed tomography. Surg Today 2010; 40(7): 614–619CrossRefPubMedGoogle Scholar
  8. 8.
    Wisnivesky JP, Henschke CI, Swanson S, Yankelevitz DF, Zulueta J, Marcus S, Halm EA. Limited resection for the treatment of patients with stage IA lung cancer. Ann Surg 2010; 251(3): 550–554CrossRefPubMedGoogle Scholar
  9. 9.
    Atkins BZ, Harpole DH Jr, Mangum JH, Toloza EM, D’Amico TA, Burfeind WR Jr. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimallyinvasive approach. Ann Thorac Surg 2007; 84(4): 1107–1113CrossRefPubMedGoogle Scholar
  10. 10.
    Schuchert MJ, Pettiford BL, Pennathur A, Abbas G, Awais O, Close J, Kilic A, Jack R, Landreneau JR, Landreneau JP, Wilson DO, Luketich JD, Landreneau RJ. Anatomic segmentectomy for stage I non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg 2009; 138 (6): 1318–25.e1CrossRefPubMedGoogle Scholar
  11. 11.
    Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y, Higami T. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg 2009; 35(5): 775–780, discussion 780CrossRefPubMedGoogle Scholar
  12. 12.
    Oizumi H, Kanauchi N, Kato H, Endoh M, Takeda S, Suzuki J, Fukaya K, Sadahiro M. Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg 2009; 36(2): 374–377, discussion 377CrossRefPubMedGoogle Scholar
  13. 13.
    Leshnower BG, Miller DL, Fernandez FG, Pickens A, Force SD. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg 2010; 89(5): 1571–1576CrossRefPubMedGoogle Scholar
  14. 14.
    Gossot D, Ramos R, Brian E, Raynaud C, Girard P, Strauss C. A totally thoracoscopic approach for pulmonary anatomic segmentectomies. Interact Cardiovasc Thorac Surg 2011; 12(4): 529–533CrossRefPubMedGoogle Scholar
  15. 15.
    Yang CF, D’Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg 2012; 94(2): 668–681CrossRefPubMedGoogle Scholar
  16. 16.
    Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Fukaya K, Sadahiro M. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg 2011; 141(3): 678–682CrossRefPubMedGoogle Scholar
  17. 17.
    Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 2011; 25(3): 855–860CrossRefPubMedGoogle Scholar
  18. 18.
    Liao HJ, Dong C, Kong FJ, Zhang ZP, Huang P, Chang S. The CUSUM analysis of the learning curve for endoscopic thyroidectomy by the breast approach. Surg Innov 2014; 21(2): 221–228CrossRefPubMedGoogle Scholar
  19. 19.
    McKenna RJ Jr. Complications and learning curves for videoassisted thoracic surgery lobectomy. Thorac Surg Clin 2008; 18(3): 275–280CrossRefPubMedGoogle Scholar
  20. 20.
    Zhao H, Bu L, Yang F, Li J, Li Y, Wang J. Video-assisted thoracoscopic surgery lobectomy for lung cancer: the learning curve. World J Surg 2010; 34(10): 2368–2372CrossRefPubMedGoogle Scholar
  21. 21.
    Meyer M, Gharagozloo F, Tempesta B, Margolis M, Strother E, Christenson D. The learning curve of robotic lobectomy. Int J Med Robot 2012; 8(4): 448–452CrossRefPubMedGoogle Scholar
  22. 22.
    Guo W, Zou YB, Ma Z, Niu HJ, Jiang YG, Zhao YP, Gong TQ, Wang RW. One surgeon’s learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral position: how many cases are needed to reach competence? Surg Endosc 2013; 27(4): 1346–1352CrossRefPubMedGoogle Scholar
  23. 23.
    Williams SM, Parry BR, Schlup MM. Quality control: an application of the cusum. BMJ 1992; 304(6838): 1359–1361CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Mawatari T, Murakami G, Koshino T, Morishita K, Abe T. Posterior pulmonary lobe: segmental and vascular anatomy in human specimens. Clin Anat 2000; 13(4): 257–262CrossRefPubMedGoogle Scholar

Copyright information

© Higher Education Press and Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryThe First Affiliated Hospital of Nanjing Medical UniversityNanjingChina

Personalised recommendations