Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan.
Department of Surgery II, Yamagata University Faculty of Medicine, Yamagata, Japan.
J Thorac Cardiovasc Surg. 2018 Nov;156(5):1995-2003. doi: 10.1016/j.jtcvs.2018.06.082. Epub 2018 Jul 20.
There have been few prospective randomized studies, but many retrospective studies strongly suggest the benefits of segmentectomy in properly selected patients. The indications for video-assisted thoracic surgery segmentectomy are growing because of the effectiveness and minimal invasiveness of the procedure. The aim of the present study was to analyze the learning curve for video-assisted thoracic surgery segmentectomy procedures in our institution.
We prospectively collected data from patients undergoing video-assisted thoracic surgery segmentectomy and retrospectively reviewed 252 patients from 2004 to 2015. Operative time, bleeding, and complications were analyzed. The learning curve was evaluated using operative time and the cumulative sum value of operative time in all cases with regard to the leading surgeon and nonleading surgeon at our institution.
Once we applied the cumulative sum method to all cases, we obtained a graph for the cumulative sum value of operative time that showed 3 well-differentiated phases: phase 1 (n = 61), the initial learning phase; phase 2 (n = 23), the increased competence phase; and phase 3 (n = 168), the highest skill phase. As we compared phases 1 and 2 with phase 3, we observed significant differences in relation to operative time (P < .001) and bleeding (P < .001). Without level 3 segmentectomy, we observed a significant reduction in operative time after 32 cases for the leading surgeon and a significant reduction in operative time and bleeding after 38 cases for the nonleading surgeon.
The data suggest that the inflection point for the learning curve was achieved after 84 cases in our institution. Therefore, increased aptitude with video-assisted thoracic surgery is achievable within a relatively short time.
虽然前瞻性随机研究较少，但许多回顾性研究强烈表明了在合适的患者中进行节段切除术的益处。由于该手术的有效性和微创性，电视辅助胸腔镜手术（VATS）节段切除术的适应证正在不断扩大。本研究旨在分析我们机构中 VATS 节段切除术的学习曲线。
我们前瞻性地收集了接受 VATS 节段切除术的患者的数据，并回顾性分析了 2004 年至 2015 年的 252 例患者。分析了手术时间、出血量和并发症。我们根据我们机构的主刀医生和非主刀医生，使用手术时间和所有病例的手术时间累积和值评估学习曲线。
一旦我们将累积和方法应用于所有病例，我们获得了一个手术时间累积和值的图表，该图表显示了 3 个明显不同的阶段：第 1 阶段（n=61），初始学习阶段；第 2 阶段（n=23），能力提高阶段；第 3 阶段（n=168），技能最高阶段。当我们将第 1 阶段和第 2 阶段与第 3 阶段进行比较时，我们观察到手术时间（P<.001）和出血量（P<.001）存在显著差异。没有 3 级节段切除术，主刀医生的手术时间在第 32 例后显著减少，非主刀医生的手术时间和出血量在第 38 例后显著减少。
数据表明，我们机构的学习曲线拐点出现在 84 例之后。因此，在相对较短的时间内，VATS 的技能可以得到提高。
