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The learning curve on uniportal video-assisted thoracic surgery: An analysis of proficiency.

单孔胸腔镜手术的学习曲线: 熟练程度分析。

  • 影响因子:1.52
  • DOI:10.1016/j.jtcvs.2019.11.006
  • 作者列表:"Vieira A","Bourdages-Pageau E","Kennedy K","Ugalde PA
  • 发表时间:2020-06-01
Abstract

OBJECTIVES:Minimally invasive techniques for lung cancer surgery have revolutionized thoracic surgery, and single-port approaches are becoming increasingly used. We analyzed our experience with uniportal video-assisted thoracoscopic surgery for lobectomy to identify the number of procedures necessary to achieve proficiency according to clinical outcomes. METHODS:We queried our institutional prospective database for all single-port lobectomies in patients with early-stage lung cancer performed by a single surgeon from 2014 to 2017; 274 patients met the inclusion criteria. Using cubic splines, we derived 3 distinct learning phases based on the length of the procedure. Blood loss, additional port insertion, and conversion to thoracotomy were also compared according to these learning phases. RESULTS:The initial phase (procedures 1-60) had the longest procedure times and the most variability in procedure length (158.8 ± 52.2 minutes) compared with the transition phase (procedures 61-140; 145.9 ± 43.8 minutes) and the proficient phase (procedures 141-274; 117.9 ± 32.6 minutes, P < .001). Blood loss (156 mL vs 130.4 mL vs 64.9 mL, P = .003), conversion rate to thoracotomy (11.7% vs 3.8% vs 0.7%, P = .001), and need for a second incision (8.3% vs 5% vs 0.7%, P = .025) were all highest during the initial phase. In a multivariable model, there was a significant interaction between procedure number and learning phase (P = .003), indicating that the effect of each additional procedure on procedure length differed in each phase. CONCLUSIONS:In this analysis, a distinct learning curve for uniportal video-assisted thoracoscopic surgery lobectomy was observed. Procedure time decreased sharply at approximately the 60th procedure, but 80 additional lobectomies were required to master the approach.

摘要

目的: 肺癌手术的微创技术已经彻底改变了胸外科手术,单孔入路的应用日益增多。我们分析了我们的单孔胸腔镜肺叶切除术的经验,以根据临床结果确定达到熟练操作所需的手术数量。 方法: 我们在我们的机构前瞻性数据库中查询了 2014 年至 2017 年由单一外科医生进行的早期肺癌患者的所有单孔肺叶切除术; 274 例患者符合纳入标准。使用三次样条,我们基于程序的长度导出了 3 个不同的学习阶段。根据这些学习阶段,还比较了失血、额外的端口插入和向开胸的转化。 结果: 与过渡阶段 (程序 61-158.8) 相比,初始阶段 (程序 1-60) 具有最长的程序时间和最大的程序长度变异性 (52.2 ± 140 分钟); 145.9 ± 43.8 分钟) 和熟练阶段 (程序 141-274; 117.9 ± 32.6 分钟,P <.001)。出血量 (156 mL vs 130.4 mL vs 64.9 mL,P = .003),中转开胸率 (11.7% vs 3.8% vs 0.7%,P = .001),第二次切口的需求 (8.3% vs 5% vs 0.7%,P = .025) 在初始阶段都是最高的。在多变量模型中,程序数量和学习阶段之间存在显著的相互作用 (P = .003),表明每个附加程序对程序长度的影响在每个阶段不同。 结论: 在这项分析中,我们观察到了单孔胸腔镜肺叶切除术的学习曲线。大约在第 60 次手术时,手术时间急剧减少,但需要另外 80 例肺叶切除术才能掌握该方法。

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影响因子:6.93
发表时间:2020-01-15
DOI:10.1002/ijc.32532
作者列表:["Hata A","Nakajima T","Matsusaka K","Fukuyo M","Morimoto J","Yamamoto T","Sakairi Y","Rahmutulla B","Ota S","Wada H","Suzuki H","Matsubara H","Yoshino I","Kaneda A"]

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翻译标题与摘要 下载文献
影响因子:6.93
发表时间:2020-01-01
DOI:10.1002/ijc.32530
作者列表:["Zhang L","Yang Y","Chai L","Bu H","Yang Y","Huang H","Ran J","Zhu Y","Li L","Chen F","Li W"]

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肺肿瘤,又叫支气管肺癌,是常见的恶性肿瘤之一。肺肿瘤的治疗为包括手术、中药、放疗、化疗及免疫等多学科的综合治疗。

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