Skip to main content
SpringerLink
Log in

Learning curve of totally thoracoscopic pulmonary segmentectomy

  • Letter to Frontiers of Medicine
  • Published:
Frontiers of Medicine Aims and scope Submit manuscript

Abstract

Totally thoracoscopic pulmonary segmentectomy (TTPS) is a feasible and safe technique that requires advanced thoracoscopic skills and knowledge of pulmonary anatomy. However, data describing the learning curve of TTPS have yet to be obtained. In this study, 128 patients who underwent TTPS between September 2010 and December 2013 were retrospectively analyzed to evaluate the learning curve and were divided chronologically into three phases, namely, ascending phase (A), plateau phase (B), and descending phase (C), through cumulative summation (CUSUM) for operative time (OT). Phases A, B, and C comprised 39, 33, and 56 cases, respectively. OT and blood loss decreased significantly from phases A to C (P < 0.01), and the frequency of intraoperative bronchoscopy for target bronchus identification decreased gradually (A, 8/39; B, 4/33; C, 3/56; P = 0.06). No significant differences were observed in demographic factors, conversion, complications, hospital stay, and retrieved lymph nodes among the three phases. Surgical outcomes and techniques improved with experience and volume. CUSUMOT indicated that the learning curve of TTPS should be more than 72 cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Churchill ED, Belsey R. Segmental pneumonectomy in bronchiectasis: the lingual segment of the left upper lobe. Ann Surg 1939; 109 (4): 481–499

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Schuchert MJ, Abbas G, Awais O, Pennathur A, Nason KS, Wilson DO, Siegfried JM, Luketich JD, Landreneau RJ. Anatomic segmentectomy for the solitary pulmonary nodule and early-stage lung cancer. Ann Thorac Surg 2012; 93(6): 1780–1787, discussion 1786–1787

    Article  PubMed  Google Scholar 

  3. Landreneau RJ, Normolle DP, Christie NA, Awais O, Wizorek JJ, Abbas G, Pennathur A, Shende M, Weksler B, Luketich JD, Schuchert MJ. Recurrence and survival outcomes after anatomic segmentectomy versus lobectomy for clinical stage I non-small-cell lung cancer: a propensity-matched analysis. J Clin Oncol 2014; 32 (23): 2449–2455

    Article  PubMed  PubMed Central  Google Scholar 

  4. Okada M, Nishio W, Sakamoto T, Uchino K, Yuki T, Nakagawa A, Tsubota N. Effect of tumor size on prognosis in patients with nonsmall cell lung cancer: the role of segmentectomy as a type of lesser resection. J Thorac Cardiovasc Surg 2005; 129(1): 87–93

    Article  PubMed  Google Scholar 

  5. Yamashita S, Tokuishi K, Anami K, Moroga T, Miyawaki M, Chujo M, Yamamoto S, Kawahara K. Thoracoscopic segmentectomy for T1 classification of non-small cell lung cancer: a single center experience. Eur J Cardiothorac Surg 2012; 42(1): 83–88

    Article  PubMed  Google Scholar 

  6. Harada H, Okada M, Sakamoto T, Matsuoka H, Tsubota N. Functional advantage after radical segmentectomy versus lobectomy for lung cancer. Ann Thorac Surg 2005; 80(6): 2041–2045

    Article  PubMed  Google Scholar 

  7. Yoshimoto K, Nomori H, Mori T, Ohba Y, Shibata H, Tashiro K, Shiraishi S, Kobayashi T. A segmentectomy of the right upper lobe has an advantage over a right upper lobectomy regarding the preservation of the functional volume of the right middle lobe: analysis by perfusion single-photon emission computed tomography/computed tomography. Surg Today 2010; 40(7): 614–619

    Article  PubMed  Google Scholar 

  8. Wisnivesky JP, Henschke CI, Swanson S, Yankelevitz DF, Zulueta J, Marcus S, Halm EA. Limited resection for the treatment of patients with stage IA lung cancer. Ann Surg 2010; 251(3): 550–554

    Article  PubMed  Google Scholar 

  9. Atkins BZ, Harpole DH Jr, Mangum JH, Toloza EM, D’Amico TA, Burfeind WR Jr. Pulmonary segmentectomy by thoracotomy or thoracoscopy: reduced hospital length of stay with a minimallyinvasive approach. Ann Thorac Surg 2007; 84(4): 1107–1113

    Article  PubMed  Google Scholar 

  10. Schuchert MJ, Pettiford BL, Pennathur A, Abbas G, Awais O, Close J, Kilic A, Jack R, Landreneau JR, Landreneau JP, Wilson DO, Luketich JD, Landreneau RJ. Anatomic segmentectomy for stage I non-small-cell lung cancer: comparison of video-assisted thoracic surgery versus open approach. J Thorac Cardiovasc Surg 2009; 138 (6): 1318–25.e1

    Article  PubMed  Google Scholar 

  11. Watanabe A, Ohori S, Nakashima S, Mawatari T, Inoue N, Kurimoto Y, Higami T. Feasibility of video-assisted thoracoscopic surgery segmentectomy for selected peripheral lung carcinomas. Eur J Cardiothorac Surg 2009; 35(5): 775–780, discussion 780

    Article  PubMed  Google Scholar 

  12. Oizumi H, Kanauchi N, Kato H, Endoh M, Takeda S, Suzuki J, Fukaya K, Sadahiro M. Total thoracoscopic pulmonary segmentectomy. Eur J Cardiothorac Surg 2009; 36(2): 374–377, discussion 377

    Article  PubMed  Google Scholar 

  13. Leshnower BG, Miller DL, Fernandez FG, Pickens A, Force SD. Video-assisted thoracoscopic surgery segmentectomy: a safe and effective procedure. Ann Thorac Surg 2010; 89(5): 1571–1576

    Article  PubMed  Google Scholar 

  14. Gossot D, Ramos R, Brian E, Raynaud C, Girard P, Strauss C. A totally thoracoscopic approach for pulmonary anatomic segmentectomies. Interact Cardiovasc Thorac Surg 2011; 12(4): 529–533

    Article  PubMed  Google Scholar 

  15. Yang CF, D’Amico TA. Thoracoscopic segmentectomy for lung cancer. Ann Thorac Surg 2012; 94(2): 668–681

    Article  PubMed  Google Scholar 

  16. Oizumi H, Kanauchi N, Kato H, Endoh M, Suzuki J, Fukaya K, Sadahiro M. Anatomic thoracoscopic pulmonary segmentectomy under 3-dimensional multidetector computed tomography simulation: a report of 52 consecutive cases. J Thorac Cardiovasc Surg 2011; 141(3): 678–682

    Article  PubMed  Google Scholar 

  17. Bokhari MB, Patel CB, Ramos-Valadez DI, Ragupathi M, Haas EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 2011; 25(3): 855–860

    Article  PubMed  Google Scholar 

  18. Liao HJ, Dong C, Kong FJ, Zhang ZP, Huang P, Chang S. The CUSUM analysis of the learning curve for endoscopic thyroidectomy by the breast approach. Surg Innov 2014; 21(2): 221–228

    Article  PubMed  Google Scholar 

  19. McKenna RJ Jr. Complications and learning curves for videoassisted thoracic surgery lobectomy. Thorac Surg Clin 2008; 18(3): 275–280

    Article  PubMed  Google Scholar 

  20. Zhao H, Bu L, Yang F, Li J, Li Y, Wang J. Video-assisted thoracoscopic surgery lobectomy for lung cancer: the learning curve. World J Surg 2010; 34(10): 2368–2372

    Article  PubMed  Google Scholar 

  21. Meyer M, Gharagozloo F, Tempesta B, Margolis M, Strother E, Christenson D. The learning curve of robotic lobectomy. Int J Med Robot 2012; 8(4): 448–452

    Article  PubMed  Google Scholar 

  22. Guo W, Zou YB, Ma Z, Niu HJ, Jiang YG, Zhao YP, Gong TQ, Wang RW. One surgeon’s learning curve for video-assisted thoracoscopic esophagectomy for esophageal cancer with the patient in lateral position: how many cases are needed to reach competence? Surg Endosc 2013; 27(4): 1346–1352

    Article  PubMed  Google Scholar 

  23. Williams SM, Parry BR, Schlup MM. Quality control: an application of the cusum. BMJ 1992; 304(6838): 1359–1361

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Mawatari T, Murakami G, Koshino T, Morishita K, Abe T. Posterior pulmonary lobe: segmental and vascular anatomy in human specimens. Clin Anat 2000; 13(4): 257–262

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 81572263), Natural Science Foundation of Jiangsu Province (No. BK20151584), Jiangsu Top Expert Program in Six Professions (No. WSW-028), Major Program of Science and Technology Foundation of Jiangsu Province (No. BE2016790), Jiangsu Medical Young Talent Project (No. QNRC2016566), the Program of Jiangsu Medical Innovation Team (No. CXTDA2017006), and Jiangsu Province 333 Talents Project (No. BRA2017545).

Author information

Author notes

  1. Weibing Wu and Jing Xu contributed equally to this study.

Authors and Affiliations

  1. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Weibing Wu, Jing Xu, Wei Wen, Yue Yu, Xinfeng Xu, Quan Zhu & Liang Chen

Authors
  1. Weibing Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jing Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wei Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yue Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xinfeng Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Quan Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Liang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Quan Zhu or Liang Chen.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, W., Xu, J., Wen, W. et al. Learning curve of totally thoracoscopic pulmonary segmentectomy. Front. Med. 12, 586–592 (2018). https://doi.org/10.1007/s11684-017-0566-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11684-017-0566-z

Keywords

Search

Navigation