Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.
Department of Surgery and Cancer Research Center, The University of Chicago, Chicago, Ill.
J Thorac Cardiovasc Surg. 2014 Apr;147(4):1150-4. doi: 10.1016/j.jtcvs.2013.11.036. Epub 2013 Dec 21.
Thoracoscopic lobectomy has a vaguely defined learning curve for competency, whereas the development of proficiency has not been evaluated. We compared learning curves for 2 surgeons experienced in open lobectomy to define the learning process for thoracoscopic lobectomy.
The first 200 patients who underwent thoracoscopic lobectomy by 1 senior surgeon at 2 different institutions were evaluated. Data were abstracted from prospectively maintained databases. Learning curves were evaluated for operative time, blood loss, and postoperative length of stay by assessing elements of proficiency: efficiency (defined as decreasing values for these variables, assessed by Change-Point Analysis) and consistency (defined as the absence of outliers, evaluated by moving average). Conversion to open rates and complication rates were assessed.
Surgeon A's patients were younger than Surgeon B's patients (57.4 vs 66.0 years; P < .001) and had fewer medical comorbidities. For Surgeons A and B, operation time (mean, 178 vs 180 minutes) efficiency was achieved at 157 and 108 cases, respectively, and blood loss (mean 181 vs 178 mL) efficiency was achieved at 126 and 139 cases, respectively. Conversion to open rates decreased between the first and second halves of the study (P < .001) despite expanding anatomic indications for a video-assisted thoracic surgery approach. Consistency was not reliably achieved for either surgeon for operating time or blood loss. Postoperative length of stay and complication rates did not change for either surgeon.
The learning curves for video-assisted thoracoscopic lobectomy were similar for both surgeons. Between 100 and 200 cases are required to achieve efficiency, and consistency requires even more cases.
胸腔镜肺叶切除术在能力上有一个模糊的学习曲线，而熟练程度的发展尚未得到评估。我们比较了 2 位经验丰富的开胸肺叶切除术医生的学习曲线，以确定胸腔镜肺叶切除术的学习过程。
评估了 2 家不同机构的 1 位资深外科医生进行的前 200 例胸腔镜肺叶切除术患者的数据。从前瞻性维护的数据库中提取数据。通过评估熟练程度的要素来评估手术时间、失血量和术后住院时间的学习曲线：效率（定义为这些变量的递减值，通过变更点分析评估）和一致性（定义为无异常值，通过移动平均值评估）。评估转化率和并发症发生率。
医生 A 的患者比医生 B 的患者年轻（57.4 岁比 66.0 岁；P<.001），且合并症较少。对于医生 A 和 B，手术时间（平均 178 分钟比 180 分钟）效率分别在 157 例和 108 例时达到，失血量（平均 181 毫升比 178 毫升）效率分别在 126 例和 139 例时达到。尽管扩大了胸腔镜手术方法的解剖适应证，但开胸率在研究的前半部分和后半部分之间下降（P<.001）。对于手术时间或失血量，两位医生均未可靠地达到一致性。对于两位医生，术后住院时间和并发症发生率均未改变。
对于两位外科医生，胸腔镜辅助肺叶切除术的学习曲线相似。需要完成 100 到 200 例手术才能达到效率，而一致性则需要更多的病例。
