Abstract

 

OBJECTIVES

When lung cancer evolves from a large, centrally located mass to small, peripherally located pulmonary nodules, such as ground glass nodules, segmentectomy offers a reasonable method by which to save lung parenchyma without eliciting compromising oncological effects. To master these techniques, it is important to analyse the learning curve of surgeons. Therefore, the aim of the present study was to analyse the learning curve for two-port video-assisted thoracoscopic surgery (VATS) segmentectomy in our institution.

METHODS

We retrospectively collected data from 86 consecutive patients who underwent two-port VATS segmentectomy between June 2019 and November 2019. The operative time (OT) and estimated blood loss and other complications were analysed. The learning curve was evaluated using the OT and the cumulative sum (CUSUM) value of OTs across all cases.

RESULTS

We generated a graph of the CUSUM of OTs and found that the learning curve could be differentiated into 3 phases: phase 1, the initial learning phase (1st to 27th operation); phase 2, the increased competence phase (28th to 54th operation); and phase 3, the experienced phase (55th to 86th operation). The CUSUM value inflected at patient number 47. There were significant reductions in the OT and bleeding in phase 3 relative to phases 1 and 2. There were also significant differences in OT and estimated blood loss between the simple and complex segmentectomy procedures.

CONCLUSIONS

In conclusion, the 3 phases identified using CUSUM analysis of the OT represented characteristic stages of the learning curve for two-port VATS segmentectomy. The data indicate that, in our institution, the inflection point for the learning curve was achieved after operating on 47 cases.

中文翻译：

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双端口电视胸腔镜手术肺段切除术的学习曲线

摘要

 

目标

当肺癌从位于中心的大肿块发展为位于外周的小的肺结节（例如磨玻璃结节）时，肺段切除术提供了一种合理的方法，可以在不影响肿瘤学效果的情况下挽救肺实质。要掌握这些技术，分析外科医生的学习曲线非常重要。因此，本研究的目的是分析我们机构双端口电视胸腔镜手术 (VATS) 肺段切除术的学习曲线。

方法

我们回顾性收集了 2019 年 6 月至 2019 年 11 月期间接受双孔 VATS 肺段切除术的 86 例连续患者的数据。分析了手术时间 (OT) 和估计失血量和其他并发症。使用 OT 和所有案例中 OT 的累积和 (CUSUM) 值评估学习曲线。

结果

我们生成了 OT 的 CUSUM 图，发现学习曲线可以分为 3 个阶段：第 1 阶段，初始学习阶段（第 1 到第 27 次操作）；第 2 阶段，提高能力阶段（第 28 至第 54 次手术）；第三阶段，经验阶段（第 55 至 86 次手术）。CUSUM 值在 47 号患者处发生变化。与第 1 和第 2 阶段相比，第 3 阶段的 OT 和出血显着减少。在简单和复杂的肺段切除术之间，OT 和估计失血量也存在显着差异。

结论

总之，使用 OT 的 CUSUM 分析确定的 3 个阶段代表了双端口 VATS 肺段切除术学习曲线的特征阶段。数据表明，在我们的机构中​​，学习曲线的拐点是在对 47 个病例进行手术后达到的。