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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

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Front. Med.    2018, Vol. 12 Issue (5) : 586-592    https://doi.org/10.1007/s11684-017-0566-z
LETTER TO FRONTIERS OF MEDICINE
Learning curve of totally thoracoscopic pulmonary segmentectomy
Weibing Wu, Jing Xu, Wei Wen, Yue Yu, Xinfeng Xu, Quan Zhu(), Liang Chen()
Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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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     
Corresponding Author(s): Quan Zhu,Liang Chen   
Just Accepted Date: 12 December 2017   Online First Date: 26 February 2018    Issue Date: 29 September 2018
 Cite this article:   
Weibing Wu,Jing Xu,Wei Wen, et al. Learning curve of totally thoracoscopic pulmonary segmentectomy[J]. Front. Med., 2018, 12(5): 586-592.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0566-z
https://academic.hep.com.cn/fmd/EN/Y2018/V12/I5/586
Fig.1  Operative time plotted against the case number. Blue solid points represent the row data of operative time.
Fig.2  CUSUMOT plotted against the case number. Green solid line represents the curve of best fit for the plot [a second-order polynomial with equation CUSUMOT = −0.32 (case number)2 + 38.67 case number+ 96.17, (R = 0.93)]. Purple dashed lines indicate the three phases of the cumulative sum (CUSUM) learning curve.
Parameters Phase A Phase B Phase C P
Sex, M/F (n) 14/25 15/18 20/36 0.616
Age (year) 58.8±11.0 61.5±12.0 57.9±12.0 0.363
FVC (%) 98.6±13.1 94.3±16.4 97.0±14.9 0.464
FEV1/FVC (%) 84.4±9.5 85.4±7.7 85.0±8.8 0.878
Nodule size (cm) 1.3±0.8 1.6±0.7 1.5±0.9 0.514
Diagnosis 0.844
Benign 8 5 12
Primary carcinoma 30 28 42
Metastatic carcinoma 1 0 2
Histological type of benign
Atypical adenomatous hyperplasia 4 1 4 0.504
Inflammatory pseudotumor 2 1 1
Tuberculoma 1 1 1
Fungus 0 0 2
Hamartoma 1 0 3
Bronchogenic cyst 0 1 1
Sclerosing hemangioma 0 1 0
Histological type of primary carcinoma 0.634
Adenocarcinoma in situ 11 8 13
Adenocarcinoma 18 17 28
Squamous cell carcinoma 0 2 1
Others 1 1 0
TNM staging 0.972
0 11 8 13
IA 16 17 24
IB 1 2 3
IIA 1 1 2
IIIA 1 0 0
Tab.1  Clinical characteristics of patients who underwent segmentectomy
Location Phase A Phase B Phase C P
Left upper lobe 10 7 15 0.766
S1+2+3 4 3 4
S4+5 3 2 3
S1+2/S1+2c/S3/S3+4+5 3 2 8
Left lower lobe 6 5 12 0.834
S6 3 3 6
S8+9+10 2 0 2
S8/S9+10 1 2 4
Right upper lobe 14 13 18 0.394
S1 3 5 5
S2 6 2 9
S3 4 5 2
S1+2/S2b+3a 1 1 2
Right middle lobe (S4) 0 2 0
Right lower lobe 9 6 11 0.059
S6 1 5 2
S7+8+9+10 3 0 4
S8/S7+8/S6+9+10/S9+10/S6+8+9+10 5 1 5
Tab.2  Type of totally thoracoscopic pulmonary segmentectomy
Variable Phase A Phase B Phase C P
Operative time (min) 217.2±58.9 187.0±39.9 158.7±35.9 0.000
Blood loss (mL) 51.2±27.8 37.4±24.9 24.6±33.6 0.000
Bronchoscope guide (n) 8 5 3 0.066
Conversion (n) 2 2 3 1
Length of hospital stay (d) 7.7±2.4 7.5±2.5 6.9±3.6 0.469
Retrieved lymph nodes (primary carcinoma) 8.8±5.1 8.1±5.3 7.7±6.6 0.676
Total morbidity (%) 6 (15.4%) 5 (15.2%) 7 (12.5%) 0.899
Air leakage>7 days (n) 2 2 2 0.875
Atrial fibrillation (n) 1 0 2 0.789
Pneumonia (n) 1 1 2 1
Hemoptysis>3 days (n) 2 2 1 0.603
Tab.3  Operative outcomes of segmentectomy
Variable Phase A vs. B (P) Phase B vs. C (P) Phase A vs. C (P)
Operative time 0.036 0.004 0.000
Blood loss 0.155 0.153 0.000
Tab.4  Post hoc test for operative time and blood loss
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[1] FMD-17051-OF-CL_suppl_1 Download
[1] Min ZHU, Xiang-Ning FU, Xiao-Ping CHEN. Lobectomy by video-assisted thoracoscopic surgery (VATS) for early stage of non-small cell lung cancer[J]. Front Med, 2011, 5(1): 53-60.
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