Learning Curve for Thoracoscopic Individual Basilar Segmentectomy: 18-Year Experience.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
accepted:
05
08
2023
medline:
3
10
2023
pubmed:
17
9
2023
entrez:
16
9
2023
Statut:
ppublish
Résumé
Thoracoscopic anatomical individual basilar segmentectomy remains challenging owing to the deep intraparenchymal location of the hilar structures and anatomical variations. We analyzed and reported the experience and progress of thoracoscopic anatomical individual basilar segmentectomy at our university hospital. We retrospectively examined the patients who underwent anatomical basilar segmentectomy at our institution from January 2004 to December 2021. We divided our analysis period into two parts: the first period (2004-2012) was the introductory period of video-assisted thoracoscopic surgery (VATS) segmentectomy, and the second period (2013-2021) was the maturity period of VATS segmentectomy. The learning curve of the leading surgeon in the second period was also evaluated based on the operative time and cumulative sum value of the operative time. Overall, 127 cases were evaluated, among whom 33 and 94 cases were assessed during the introductory and maturity periods of thoracoscopic segmentectomy, respectively. Age (P = 0.003) and Charlson comorbidity index (P = 0.002) were higher in the second period than in the first period. Use of a uniport (P = 0.006) was higher, and postoperative hospitalization duration (P = < 0.001) and operative time (P = 0.024) were shorter in the second period than in the first period. A learning curve obtained during the maturity period showed: The inflection point for the learning curve of thoracoscopic basilar segmentectomy was reached after 42 cases. We have demonstrated a single institution's progress and learning curve for difficult segmentectomies. This may be helpful to institutions considering performing this surgery.
Sections du résumé
BACKGROUND
Thoracoscopic anatomical individual basilar segmentectomy remains challenging owing to the deep intraparenchymal location of the hilar structures and anatomical variations. We analyzed and reported the experience and progress of thoracoscopic anatomical individual basilar segmentectomy at our university hospital.
METHODS
We retrospectively examined the patients who underwent anatomical basilar segmentectomy at our institution from January 2004 to December 2021. We divided our analysis period into two parts: the first period (2004-2012) was the introductory period of video-assisted thoracoscopic surgery (VATS) segmentectomy, and the second period (2013-2021) was the maturity period of VATS segmentectomy. The learning curve of the leading surgeon in the second period was also evaluated based on the operative time and cumulative sum value of the operative time.
RESULTS
Overall, 127 cases were evaluated, among whom 33 and 94 cases were assessed during the introductory and maturity periods of thoracoscopic segmentectomy, respectively. Age (P = 0.003) and Charlson comorbidity index (P = 0.002) were higher in the second period than in the first period. Use of a uniport (P = 0.006) was higher, and postoperative hospitalization duration (P = < 0.001) and operative time (P = 0.024) were shorter in the second period than in the first period. A learning curve obtained during the maturity period showed: The inflection point for the learning curve of thoracoscopic basilar segmentectomy was reached after 42 cases.
CONCLUSIONS
We have demonstrated a single institution's progress and learning curve for difficult segmentectomies. This may be helpful to institutions considering performing this surgery.
Identifiants
pubmed: 37716932
doi: 10.1007/s00268-023-07162-7
pii: 10.1007/s00268-023-07162-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2917-2924Informations de copyright
© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.
Références
Okada M, Koike T, Higashiyama M et al (2006) Radical sublobar resection for small-sized non-small cell lung cancer: a multicenter study. J Thorac Cardiovasc Surg 132:769–775
doi: 10.1016/j.jtcvs.2006.02.063
pubmed: 17000286
Subramanian M, McMurry T, Meyers BF et al (2018) Long-term results for clinical stage IA lung cancer: comparing lobectomy and sublobar resection. Ann Thorac Surg 106:375–381
doi: 10.1016/j.athoracsur.2018.02.049
pubmed: 29580779
pmcid: 6375491
Kodama K, Higashiyama M, Okami J et al (2016) Oncologic outcomes of segmentectomy versus lobectomy for clinical T1a N0 M0 non-small cell lung cancer. Ann Thorac Surg 101:504–511
doi: 10.1016/j.athoracsur.2015.08.063
pubmed: 26542438
Dziedzic R, Zurek W, Marjanski T et al (2017) Stage I non-small-cell lung cancer: long-term results of lobectomy versus sublobar resection from the polish national lung cancer registry. Eur J Cardiothorac Surg 52:363–369
doi: 10.1093/ejcts/ezx092
pubmed: 28402455
Schuchert MJ, Pettiford BL, Keeley S et al (2007) Anatomic segmentectomy in the treatment of stage I non-small cell lung cancer. Ann Thorac Surg 84:926–932
doi: 10.1016/j.athoracsur.2007.05.007
pubmed: 17720401
Zhao ZR, Situ DR, Lau RWH et al (2017) Comparison of segmentectomy and lobectomy in stage IA adenocarcinomas. J Thorac Oncol 12:890–896
doi: 10.1016/j.jtho.2017.01.012
pubmed: 28111235
Bedetti B, Bertolaccini L, Rocco R et al (2017) Segmentectomy versus lobectomy for stage I non-small cell lung cancer: a systematic review and meta-analysis. J Thorac Dis 9:1615–1623
doi: 10.21037/jtd.2017.05.79
pubmed: 28740676
pmcid: 5506148
Saji H, Okada M, Tsuboi M et al (2022) Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet 399:1607–1617
doi: 10.1016/S0140-6736(21)02333-3
pubmed: 35461558
Altorki N, Wang X, Kozono D et al (2023) Lobar or sublobar resection for peripheral stage IA non-small-cell lung cancer. N Engl J Med 388:489–498
doi: 10.1056/NEJMoa2212083
pubmed: 36780674
pmcid: 10036605
Yan TD (2014) Surgical atlas of thoracoscopic lobectomy and segmentectomy. Ann Cardiothorac Surg 3:183–191
pubmed: 24790843
pmcid: 3988311
Sato M, Murayama T, Nakajima J (2018) Thoracoscopic stapler-based “bidirectional” segmentectomy for posterior basal segment (S10) and its variants. J Thorac Dis 10(Supplement 10):S1179–S1186
doi: 10.21037/jtd.2018.01.31
pubmed: 29785292
pmcid: 5949398
Seguin-Givelet A, Grigoroiu M, Brian E et al (2018) Planning and marking for thoracoscopic anatomical segmentectomies. J Thorac Dis 10(Supplement 10):S1187–S1194
doi: 10.21037/jtd.2018.02.21
pubmed: 29785293
pmcid: 5949389
Takamori S, Oizumi H, Suzuki J et al (2022) Thoracoscopic anatomical individual basilar segmentectomy. Eur J Cardiothorac Surg 62:ezab509
doi: 10.1093/ejcts/ezab509
pubmed: 34964464
Liu C, Liao H, Guo C et al (2020) Single-direction thoracoscopic basal segmentectomy. J Thorac Cardiovasc Surg 160:1586–1594
doi: 10.1016/j.jtcvs.2020.01.028
pubmed: 32111428
Kikkawa T, Kanzaki M, Isaka T et al (2015) Complete thoracoscopic S9 or S10 segmentectomy through a pulmonary ligament approach. J Thorac Cardiovasc Surg 149:937–939
doi: 10.1016/j.jtcvs.2014.10.111
pubmed: 25467374
Oizumi H, Kato H, Suzuki J et al (2018) Thoracoscopic anatomical S10 segmentectomy: a posterior approach. J Vis Surg 4:142
doi: 10.21037/jovs.2018.06.15
Endoh M, Oizumi H, Kato H et al (2017) Posterior approach to thoracoscopic pulmonary segmentectomy of the dorsal basal segment: a single-institute retrospective review. J Thorac Cardiovasc Surg 154:1432–1439
doi: 10.1016/j.jtcvs.2017.03.120
pubmed: 28461056
Igai H, Kamiyoshihara M, Kawatani N et al (2017) Thoracoscopic lateral and posterior basal (S
pubmed: 28329097
Shimizu K, Nagashima T, Yajima T et al (2017) Thoracoscopic medial-basal segment segmentectomy. Ann Thorac Surg 104:e403–e406
doi: 10.1016/j.athoracsur.2017.07.006
pubmed: 29054240
Hamada A, Oizumi H, Kato H et al (2018) Learning curve for port-access thoracoscopic anatomic lung segmentectomy. J Thorac Cardiovasc Surg 156:1995–2003
doi: 10.1016/j.jtcvs.2018.06.082
pubmed: 30121137
Oizumi H, Kanauchi N, Kato H et al (2011) Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg 141:678–682
doi: 10.1016/j.jtcvs.2010.08.027
pubmed: 20884021
Endoh M, Oizumi H, Kato H et al (2017) How to demarcate intersegmental plane with resected-segments inflation method using the slip knot technique in thoracoscopic anatomic segmentectomy. J Vis Surg 3:100
doi: 10.21037/jovs.2017.06.11
pubmed: 29078662
pmcid: 5637722
Suzuki J, Oizumi H, Watanabe H et al (2023) Revaluation of a selected segmental insufflation technique in total thoracoscopic lung segmentectomy. Interdiscip Cardiovasc Thorac Surg 36:ivad054
doi: 10.1093/icvts/ivad054
pubmed: 37014378
pmcid: 10120158
Dimitrovska NT, Bao F, Yuan P et al (2022) Learning curve for two-port video-assisted thoracoscopic surgery lung segmentectomy. Interact Cardiovasc Thorac Surg 34:402–407
doi: 10.1093/icvts/ivab236
pubmed: 34480175
Zhang Y, Liu S, Han Y et al (2019) Robotic anatomical segmentectomy: an analysis of the learning curve. Ann Thorac Surg 107:1515–1522
doi: 10.1016/j.athoracsur.2018.11.041
pubmed: 30578780
Zhu Y, Pu Q, Liu L (2018) Trans-inferior-pulmonary-ligament VATS basal segmentectomy: application of single-direction strategy in segmentectomy of left S9+10. J Thorac Dis 10:6266–6268
doi: 10.21037/jtd.2018.10.82
pubmed: 30622800
pmcid: 6297422
Pu Q, Liu C, Guo C et al (2019) Stem-branch: a novel method for tracking the anatomy during thoracoscopic S9–10 segmentectomy. Ann Thorac Surg 108:e333–e335
doi: 10.1016/j.athoracsur.2019.05.046
pubmed: 31288018
Yamanashi K, Okumura N, Otsuki Y et al (2017) Stapler-based thoracoscopic basilar segmentectomy. Ann Thorac Surg 104:e399–e402
doi: 10.1016/j.athoracsur.2017.06.048
pubmed: 29054239
Chaput de Saintonge DM, Vere DW (1974) Why don’t doctors use cusums. Lancet 1:120–121
doi: 10.1016/S0140-6736(74)92345-9
pubmed: 4130314
Wohl H (1977) The cusum plot: its utility in the analysis of clinical data. N Engl J Med 296:1044–1045
doi: 10.1056/NEJM197705052961806
pubmed: 846547
Khan N, Abboudi H, Khan MS et al (2014) Measuring the surgical ‘learning curve’: methods, variables and competency. BJU Int 113:504–508
doi: 10.1111/bju.12197
pubmed: 23819461