Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan;9(1):138-142.
doi: 10.21037/jtd.2017.01.03.

Learning curve and established phase for uniportal VATS lobectomies: the Papworth experience

Benedetta Bedetti  1 , Luca Bertolaccini  2 , Piergiorgio Solli  1 , Marco Scarci  2
Affiliations

Learning curve and established phase for uniportal VATS lobectomies: the Papworth experience

Benedetta Bedetti et al. J Thorac Dis. 2017 Jan.

Abstract

Background: Uniportal video-assisted thoracoscopy (VATS) has increasingly gained importance in the thoracic surgery scenario. The use of this technique can reduce postoperative pain and length of stay and gives the surgeon the same operative perspective as open surgery.

Methods: We retrospectively analysed the data of 73 patients who underwent uniportal VATS lobectomies from November 2014 to December 2015 in our institution. We divided the patients in two groups (group 1: first 30 patients vs. group 2: established phase, 43 patients) to compare and evaluate the data regarding the learning curve. 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 analysis.

Results: The median age was 69.9 (group 1) and 68.8 (group 2) years. Mean operative time was 84.9±33.0 (group 1) and 84.8±31.5 (group 2) minutes. The conversion rate was 13.3% in group 1 vs. 9.3% in group 2, showing a significant learning reduction (rho=0.590). Overall morbidity rate was 15.1%. The most common complication consisted in prolonged air leak. 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 vs. 3 days in group 2. The 30-day mortality was 3.3% in group 1 and 0% in group 2.

Conclusions: The comparison between the groups showed that the median length of stay, operative time, conversion rate and 30-day mortality statistically significantly improved in the established phase. Also, complications like prolonged air leak were decreasing in the 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.

Keywords: Learning curve; established phase; uniportal video-assisted thoracoscopy lobectomies (uniportal VATS lobectomies).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Graph representing the cumulative failure (conversion rate to thoracotomy) in relation to the learning curve.
Figure 2
Figure 2
Graph representing the complication rate in relation to the learning curve.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bedetti B, Scarci M, Gonzalez-Rivas D. Technical steps in single port video-assisted thoracoscopic surgery lobectomy. J Vis Surg 2016;2:45 10.21037/jovs.2016.02.18 - DOI - PMC - PubMed
    1. Salati M, Brunelli A, Rocco G. Uniportal video-assisted thoracic surgery for diagnosis and treatment of intrathoracic conditions. Thorac Surg Clin 2008;18:305-10, vii. 10.1016/j.thorsurg.2008.04.005 - DOI - PubMed
    1. Anile M, Diso D, Mantovani S, et al. Uniportal video assisted thoracoscopic lobectomy: going directly from open surgery to a single port approach. J Thorac Dis 2014;6:S641-3. - PMC - PubMed
    1. Jutley RS, Khalil MW, Rocco G. Uniportal vs standard three-port VATS technique for spontaneous pneumothorax: comparison of post-operative pain and residual paraesthesia. Eur J Cardiothorac Surg 2005;28:43-6. 10.1016/j.ejcts.2005.02.039 - DOI - PubMed
    1. Bertolaccini L, Rocco G, Viti A, et al. Geometrical characteristics of uniportal VATS. J Thorac Dis 2013;5 Suppl 3:S214-6. - PMC - PubMed

LinkOut - more resources