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Scoping review of learning curve methods in minimally invasive thoracic surgery

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Abstract

Purpose

The objective of this scoping review is to determine how learning curves are assessed in the thoracic surgical literature for video- and robot-assisted thoracic lung resections.

Methods

This scoping review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A literature search was conducted, using four electronic databases: Ovid Medline, Ovid Embase, EBSCO CINAHL, and Web of Science. Two reviewers independently screened studies, extracted data, and assessed quality, with a third reviewer to resolve conflicts. Included studies were peer-reviewed primary data, that were written in English and evaluated the learning curve of minimally invasive anatomical segmental resection, lobectomy, pneumonectomy, wedge resection, and combinations of various lung resections.

Results

The search yielded a total of 1614 articles. After the screening phases, 56 articles remained eligible for inclusion. The most common method used to construct the learning curve was the chronological grouping of cases (split-group analysis), which was performed in 22 (39.29%) studies. The cumulative sum (CUSUM) method was the second most commonly used approach for evaluating the learning curve, used in 21 (37.50%) studies. Across the 56 included studies, a total of 15 unique outcomes were used for the learning curve analyses. The most commonly used learning curve outcome was operative time, which was used in 39 (69.64%) of the studies.

Conclusion

This scoping review explored the problem of heterogeneity in learning curve study methodology. Variation in study methods makes comparisons of the learning curves between and within different surgical procedures difficult. Therefore, further investigation in the uptake of set reporting standards in learning curve methodology may allow for the use of informing medical curricula, physician education, and quality control monitoring processes.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada

    Yogita S. Patel & Waël C. Hanna

  2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Nikkita Mistry, Forough Farrokhyar, Marko Simunovic & Waël C. Hanna

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  1. Yogita S. Patel
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Correspondence to Waël C. Hanna.

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Honourable mention to Peter Malik, MSc for his assistance.

Appendix

Appendix

Appendix 1. Medline search strategy

  1. 1.

    ((Lung OR pulmonary) adj2 (lobectomy* OR segmentectom* OR thymectom* OR resect* OR reduction OR excis*)).ti,ab,kw,kf.

  2. 2.

    (Pneumoresection* or pneumectom* or pneumonectom*).ti,ab,kw,kf.

  3. 3.

    Thoracotomy/

  4. 4.

    Thoracotom*.mp.

  5. 5.

    (Lung adj2 (reduction or resect* or excis*)).ti,ab,kw,kf.

  6. 6.

    Lung Disease*.mp.

  7. 7.

    Lung Neoplasms/

  8. 8.

    ((Lung or pulmonary) adj2 (adenocarcinoma* or cancer* or neoplas* or tumo?r* or malignan* or carcinoma* or metas* or carcinogenesis or sarcoma*)).mp.

  9. 9.

    Or/1–8

  10. 10.

    Minimally invasive surgical procedures/ or thoracoscopy/

  11. 11.

    (Minimally invasive surgical procedure* or thoracoscop* or video-assist* or uniport*).mp.

  12. 12.

    Robotics/ or robotic surgical procedures/

  13. 13.

    Robot*.mp.

  14. 14.

    Or/10–13

  15. 15.

    9 and 14

  16. 16.

    Thoracic surgery, video-assisted/

  17. 17.

    (VATS or video assisted thora* or or video-assisted thora*).mp.

  18. 18.

    (Video adj3 thora*).mp.

  19. 19.

    Or/15–18

  20. 20.

    Learning curve/

  21. 21.

    Learning curve*.mp.

  22. 22.

    Learning/

  23. 23.

    Skill acquisition.mp.

  24. 24.

    Clinical Competence/

  25. 25.

    (Clinical adj2 (skill* or competenc*)).mp.

  26. 26.

    “Outcome and Process Assessment, Health Care”/sn [Statistics & Numerical Data]

  27. 27.

    Or/20–26

  28. 28.

    19 and 27

Appendix 2. PRISMA-ScR flow diagram

figure a

Appendix 3. Characteristics of included studies

See Table 1

Table 1 Characteristics of Included Studies
Full size table

Appendix 4. Number of learning curve studies from 1990-present

figure b

Appendix 5. Learning curve study methodology

See Table 2

Table 2 Learning curve study methodology
Full size table

Appendix 6. Learning curve outcomes reported per study

figure c

Appendix 7a. Outcomes used to evaluate the learning curve

See Table 3.

Table 3 Outcomes used to evaluate the learning curve
Full size table

Appendix 7b. Outcomes used for assessing learning curves in the included studies

figure d

Appendix 7c. Distribution of variables used to measure the learning curve according to the donabedian model

figure e

Appendix 8. Graphical representations of learning curves

See Table 4

Table 4 Graphical representations of learning curves
Full size table

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Patel, Y.S., Mistry, N., Farrokhyar, F. et al. Scoping review of learning curve methods in minimally invasive thoracic surgery. Global Surg Educ 2, 81 (2023). https://doi.org/10.1007/s44186-023-00158-w

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