Uniportal video-assisted thoracoscopic early learning curve for major lung resections in a high volume training center

Abstract

Background: Uniportal video-assisted thoracoscopic surgery (VATS) for major lung resections is a novel upcoming approach, with increasing popularity worldwide. However, there is little literature regarding this technique's learning curve. We present our experience of the early learning curve of the uniportal VATS major lung resections in a high volume training centre, whilst analysing the advantages.

Methods: Sixty selected consecutive patients underwent uniportal VATS major lung resections, for early stage disease of NSCLC and benign disease during the learning curve of a single surgeon in a high volume training centre from July to October 2015. The perioperative variables and outcomes were collected prospectively and analysed retrospectively.

Results: The 60 patients undergoing a uniportal VATS approach included 47 lobectomies and 13 segmental resections, among which 56 cases of lung cancer and 4 of benign pulmonary disease were noted. Right upper lobectomy (RUL) was the most common procedure (42%). The mean operation time was 192.3±45.4 minutes, average blood loss was 167.9±94.4 mL. For patients with lung cancer, the total amount of lymph node stations sampled or dissected were 4.2±0.8. Chest drain duration was 2.9±0.9 days and length of hospital stay (LOS) was 4.38±1 days. Prolonged air leak (PAL) was the most common complication in 8.3% of the cases. PAL was the cause of prolonged hospital stay. One case was converted to thoracotomy for major bleeding. There were no deaths 30 days after surgery or readmissions. All cases had a R0 complete cancer resection on histology.

Conclusions: The uniportal VATS lobectomy and segmentectomy early learning curve in a high volume training centre is a safe venture, allowing surgeons to reach an expert level faster and perform more complex resections with a shorter training time.

Keywords: Video-assisted thoracoscopic surgery (VATS); learning curve; uniportal.

Figure 1

Comparison on perioperative outcomes (first 30 cases vs. last 30 cases).

Figure 2

Number of cases to reach expert level according to the duration of surgery.