Divisi Duilio, Bertolaccini Luca, Barone Mirko, Amore Dario, Argnani Desideria, Zaccagna Gino, Solli Piergiorgio, Di Rienzo Gaetano, Curcio Carlo, Crisci Roberto
Department of Thoracic Surgery, "G. Mazzini" Hospital, University of L'Aquila, Teramo, Italy.
Department of Thoracic Surgery, Maggiore Teaching Hospital, Bologna, Italy.
J Thorac Dis. 2018 Jan;10(1):330-338. doi: 10.21037/jtd.2017.11.133.
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.
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 -tests, Fisher's exact tests, Pearson's χ were applied as needed. Cumulative summative analysis and one-way ANOVA were used to identify the expertise curve of VATS lobectomy.
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).
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.
电视辅助胸腔镜手术（VATS）肺叶切除术的专业技能曲线仍存在争议，这既涉及到要开展的手术数量，也涉及到对学习门槛的评估。我们研究的目的是检查与电视辅助手术学习曲线相关的变量，以确定什么可能是外科医生技术成熟度的一种表现。
使用2013年建立的VATS肺叶切除术国家登记册，从65个胸外科单位收集数据。在超过3700名登记患者中，仅对有≥100例VATS肺叶切除术的单位的信息进行回顾性分析。根据需要应用非配对学生t检验、Fisher精确检验、Pearson卡方检验。采用累积总和分析和单因素方差分析来确定VATS肺叶切除术的专业技能曲线。
10家机构共提供了1679例患者，根据手术的时间顺序将其分为三个均匀的组。三组之间实用切口长度、清扫淋巴结数量和手术时间差异无统计学意义（分别为P = 0.999、P = 0.972和P = 0.307）。125例（7.44%）患者转为开胸手术，109例（6.49%）患者术后出现漏气，在第3组中逐渐下降，差异有统计学意义（P = 0.048和P = 0.00086）。
手术转化率和漏气百分比似乎可以定义VATS肺叶切除术的专业技能，这与处理更复杂手术病例或术中不良事件的能力有关。
