LEARNING CURVE FOR UNIPORTAL VATS LOBECTOMIES: THE PAPWORTH EXPERIENCE
Benedetta Bedetti1, Luca Bertolaccini2, Piergiorgio Solli1, Marco Scarci1.
1Papworth Hospital, Cambridge, United Kingdom, 2Sacro Cuore - Don Calabria Research Hospital, Negrar - Verona, Italy.
OBJECTIVE: Uniportal video-assisted thoracoscopy (VATS) gained importance in the thoracic surgery scenario in the last years. Major pulmonary resections such as lobectomies can be performed with a single 4-cm incision, reducing postoperative pain and often the length of stay and giving the surgeon the same operative perspective as open surgery.
METHODS: We retrospectively analysed the data of 73 patients that underwent uniportal VATS lobectomies from November 2014, when we started to introduce this technique in our institution, to December 2015. We divided the patients in two groups (group-1: first 30 patients versus group-2: established phase, 43 patients) to compare and evaluate the data regarding the learning curve and the established phase. The surgeons were already experienced in triportal VATS lobectomies. To explore evolution of learning curve, data were plotted to calculate Spearman’s Rank-Order Correlation. R (version 3.2.3) was used for statistical analyses.
RESULTS: The median age was 69.9 (group-1) and 68.8 (group-2) years.In general the indication to undergo surgery was for primary carcinoma of the lung in 67 patients (54 adenocarcinoma, 13 squamous carcinoma), for metastatic disease (3 patients) and for infectious disease (3 patients). Mean operative time was 84.9±33.0 minutes (group-1) and 84.8±31.5 (group-2), median time 97.5 minutes (group-1) and 91.3 (group-2). The conversion rate was 13.3% in the group-1 versus 9.3% in group-2, showing a significant learning reduction (rho=0.590). Overall the most common complication consisted in prolonged air leak and blood transfusion rate was 0% intra-and postoperatively. Interpolation line of complications showed a significant decrease due to learning-curve (rho=0.676). The median length of stay was 4 days in group-1 versus 3 days in the second group. 30-days mortality was 3.3% in the first group (one patient died because of aspiration and hypoxia on the second postoperative day) and 0% in group-2.
CONCLUSIONS: The comparison between the two groups shows that the median length of stay, operative time, conversion rate and 30-days mortality statistically significantly improved in the second group (established phase). In conclusion, the uniportal VATS lobectomy technique can be performed safely from experienced surgeons without major complications and with an acceptable mortality rate.
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