Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen, Denmark.
Eur J Cardiothorac Surg. 2010 Mar;37(3):516-20. doi: 10.1016/j.ejcts.2009.09.012. Epub 2009 Oct 8.
Thoracoscopic (video-assisted thoracoscopic surgery (VATS)) lobectomy is a safe and effective method for treating early-stage lung cancer. Despite this, it is still not widely practised, which could be due to a shallow learning curve. We have evaluated the surgical outcome in a training programme at an institution with an established VATS lobectomy programme. We present the surgical data and outcome of the first 50 intended VATS lobectomies performed by a consultant in training as the primary surgeon.
Data were obtained from a prospectively registered surgical database consisting of 262 consecutively intended VATS lobectomies. A single consultant performed 212 intended VATS lobectomies. His first 50 intended VATS lobectomies were excluded, as they were considered to be his learning curve, leaving 162 intended VATS lobectomies, of which 12 were converted to open lobectomy, performed from January 2005 to April 2008. Fifty intended VATS lobectomies were performed by a consultant in a training programme for VATS lobectomies, of which three were converted to open lobectomy from April 2007 to April 2008. The training consultant was experienced in open thoracic surgery and had performed more than 200 minor VATS procedures prior to the training programme. The surgical data and outcome between the 47 VATS lobectomies were compared with the 150 VATS lobectomies performed by the experienced consultant using statistical analysis.
There were significantly better results for the training consultant regarding prolonged air leak, chest tube duration and length of stay, which probably reflects the careful selection of the patients favouring the training consultant. The operation time was significant longer for the consultant in training (p<0.0001).
With careful selection of patients, VATS lobectomy can be taught safely in a surgical institution experienced in VATS lobectomies. Using statistical analysis, the surgical outcome for the training consultant was acceptable in comparison to the outcome of the experienced consultant. The consultant in training did spend more time in the operating theatre (p<0.0001) and we recommend taking that into account when planning future training programmes in VATS lobectomy.
胸腔镜（电视辅助胸腔镜手术（VATS））肺叶切除术是治疗早期肺癌的一种安全有效的方法。尽管如此，它仍然没有得到广泛应用，这可能是由于学习曲线较浅。我们在一个具有成熟 VATS 肺叶切除术项目的机构中评估了培训计划中的手术结果。我们介绍了一位受训顾问作为主要外科医生进行的前 50 例计划 VATS 肺叶切除术的手术数据和结果。
数据来自一个前瞻性注册的外科数据库，该数据库由 262 例连续计划的 VATS 肺叶切除术组成。一位顾问进行了 212 例计划的 VATS 肺叶切除术。他的前 50 例计划的 VATS 肺叶切除术被排除在外，因为它们被认为是他的学习曲线，留下了 162 例计划的 VATS 肺叶切除术，其中 12 例被转换为开放性肺叶切除术，于 2005 年 1 月至 2008 年 4 月进行。在一个 VATS 肺叶切除术培训计划中，50 例计划的 VATS 肺叶切除术由一位受训顾问进行，其中 3 例从 2007 年 4 月至 2008 年 4 月被转换为开放性肺叶切除术。培训顾问在开胸手术方面经验丰富，在培训计划之前已经进行了超过 200 例小 VATS 手术。使用统计学分析比较了 47 例 VATS 肺叶切除术和 150 例由经验丰富的顾问进行的 VATS 肺叶切除术之间的手术数据和结果。
对于培训顾问来说，延长的漏气、胸腔引流管持续时间和住院时间有更好的结果，这可能反映了对患者的精心选择有利于培训顾问。受训顾问的手术时间明显较长（p<0.0001）。
在具有 VATS 肺叶切除术经验的外科机构中，通过精心选择患者，可以安全地教授 VATS 肺叶切除术。使用统计学分析，与经验丰富的顾问的结果相比，培训顾问的手术结果是可以接受的。受训顾问在手术室花费的时间确实更长（p<0.0001），我们建议在规划未来的 VATS 肺叶切除术培训计划时考虑到这一点。
