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. 2018 Jan;10(1):330-338.
doi: 10.21037/jtd.2017.11.133.

National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: the Italian VATS register evaluation

Duilio Divisi  1 , Luca Bertolaccini  2 , Mirko Barone  1 , Dario Amore  3 , Desideria Argnani  4 , Gino Zaccagna  1 , Piergiorgio Solli  2 , Gaetano Di Rienzo  5 , Carlo Curcio  3 , Roberto Crisci  1 ; Italian VATS Group
Affiliations

National adoption of video-assisted thoracoscopic surgery (VATS) lobectomy: the Italian VATS register evaluation

Duilio Divisi et al. J Thorac Dis. 2018 Jan.

Abstract

Background: The expertise curve of video-assisted thoracoscopic surgery (VATS) lobectomies still stirs debate and controversy both because of the number of procedures to carry out and of the evaluation of the learning threshold. The purpose of our study was the examination of the variables related to the learning curve of the video-assisted approach, to establish what may be an expression of the technical maturity of the surgeon.

Methods: The National Register for VATS lobectomy built in 2013 was used to collect data from 65 Thoracic Surgery Units. Out of more than 3,700 patients enrolled, only information from Units with ≥100 VATS lobectomies were retrospectively analysed. Unpaired Student's t-tests, Fisher's exact tests, Pearson's χ2 were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy.

Results: Ten institutions contributed a total of 1,679 patients, who were divided into three uniform groups according to the chronological sequence of surgery. The length of utility incision, the number of dissected lymph nodes and the operative time were not statistically significant (P=0.999, P=0.972 and P=0.307, respectively) among groups. Conversion to thoracotomy and postoperative air leaks occurred in 125 (7.44%) and 109 (6.49%) patients, gradually declined in Group 3 with statistical significance (P=0.048 and P=0.00086).

Conclusions: The conversion rate and the percentage of air leaks seem to define the expertise of VATS lobectomy, being linked to the ability to manage more complicated surgical cases or intraoperative adverse events.

Keywords: Video-assisted thoracoscopic surgery lobectomy (VATS lobectomy); database; learning curve; learning tools; non-small cell lung cancer; training.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1
Overall expertise curve of VATS lobectomy (red line). VATS, video-assisted thoracoscopic surgery.
Figure 2
Figure 2
CUSUM index revealed that statistical analysis was under control in the cumulative scraps. CUSUM, cumulative sum.
See this image and copyright information in PMC

References

    1. Roviaro G, Rebuffat C, Varoli F, et al. Videoendoscopic pulmonary lobectomy for cancer. Surg Laparosc Endosc 1992;2:244-7. - PubMed
    1. Boffa DJ, Allen MS, Grab JD, et al. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg 2008;135:247-54. 10.1016/j.jtcvs.2007.07.060 - DOI - PubMed
    1. Paul S, Sedrakyan A, Chiu YL, et al. Outcomes after lobectomy using thoracoscopy vs thoracotomy: a comparative effectiveness analysis utilizing the Nationwide Inpatient Sample database. Eur J Cardiothorac Surg 2013;43:813-7. 10.1093/ejcts/ezs428 - DOI - PubMed
    1. Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: review of a national database. Ann Thorac Surg 2014;97:236-42; discussion 242-4. 10.1016/j.athoracsur.2013.07.117 - DOI - PubMed
    1. Ceppa DP, Kosinski AS, Berry MF, et al. Thoracoscopic lobectomy has increasing benefit in patients with poor pulmonary function: a Society of Thoracic Surgeons Database analysis. Ann Surg 2012;256:487-93. 10.1097/SLA.0b013e318265819c - DOI - PMC - PubMed