Song Zuodong, Yuan Yu, Cheng Chao, Luo Qingquan, Cheng Xinghua
Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Thoracic Surgery, Dazhou Central Hospital, Sichuan, China.
Front Oncol. 2023 Mar 16;13:1085634. doi: 10.3389/fonc.2023.1085634. eCollection 2023.
OBJECTIVES: Video-assisted thoracoscopic lobectomy has become the preferred surgical approach in experienced centers, and uniportal approaches are becoming increasingly used. But the uniportal approach is still not widely applied presumably due to the learning difficulties of this complex procedure. The use of surgical videos may be helpful to accelerate the learning of this new techniques as in other fields. In this study, we aimed to analyze the learning curve of uniportal video-assisted thoracoscopic lobectomy with the help of postoperative review of videos. METHODS: 114 patients with early-stage lung cancer who underwent uniportal video-assisted thoracoscopic lobectomy performed from 2020 to 2021 were reviewed in this study. We recorded the operation video for each patient and reviewed all the videos after surgery. The learning curves were assessed using cumulative sum analysis and the collected data of perioperative outcomes were assessed. RESULTS: The CUMSUM curve showed its inflection points were around case 38 and 53. It was less compared with previous studies, which about 57-140 cases are needed to attain the proficient phase. The perioperative outcomes were similar in each phase, which included intraoperative blood loss (79.00 ± 26.70 70.67 ± 26.64 70.56 ± 27.23, p=0.0119), the length of hospital stay (3.60 ± 1.52 days . 3.23 ± 0.90 days . 3.06 ± 0.88 days, p=0.053), the rate of prolonged air leak and conversion to open thoracotomy. There was also no significant difference in the numbers and station of lymph node dissection among the three phases. CONCLUSIONS: Uniportal video-assisted thoracoscopic lobectomy is a safe and reliable approach. Recording and reviewing the operation video could help the surgeon to improve deficiencies and refine the procedure.
目的:电视辅助胸腔镜肺叶切除术已成为经验丰富的中心首选的手术方法,单孔入路的应用也越来越多。但单孔入路可能因该复杂手术的学习难度大,仍未得到广泛应用。与其他领域一样,手术视频的使用可能有助于加速这项新技术的学习。在本研究中,我们旨在通过术后视频回顾来分析单孔电视辅助胸腔镜肺叶切除术的学习曲线。 方法:本研究回顾了2020年至2021年期间接受单孔电视辅助胸腔镜肺叶切除术的114例早期肺癌患者。我们记录了每位患者的手术视频,并在术后回顾了所有视频。使用累积和分析评估学习曲线,并评估围手术期结果的收集数据。 结果:累积和曲线显示其拐点在第38例和第53例左右。与之前的研究相比,所需病例数较少,之前的研究认为达到熟练阶段需要57 - 140例。各阶段围手术期结果相似,包括术中出血量(79.00±26.70、70.67±26.64、70.56±27.23,p = 0.0119)、住院时间(3.60±1.52天、3.23±0.90天、3.06±0.88天,p = 0.053)、持续漏气率和中转开胸率。三个阶段之间淋巴结清扫的数量和部位也无显著差异。 结论:单孔电视辅助胸腔镜肺叶切除术是一种安全可靠的方法。记录和回顾手术视频有助于外科医生改进不足之处并完善手术操作。
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