Frank O Velez-Cubian, MD1, Kavian Toosi, BS2, Bryce Montane, BS2, Kathryn Rodriguez, MD2, Carla C Moodie, PAC3, Joseph R Garrett, MPH, ARNP3, Jacques P Fontaine, MD3, Eric M Toloza3. 1Department of Surgery, University of South Florida Morsani College of Medicine, Tampa Fl, 2University of South Florida Morsani College of Medicine, Tampa Fl, 3Department of Thoracic Oncology, Moffitt Cancer Center, Tampa Fl
INTRODUCTION: Use of minimally invasive surgery (MIS) has increased for lung resection, such as robotic-assisted video-assisted thoracoscopic (R-VATS) lobectomy, but little is known about its learning curve. A surgeon’s surgical training, previous experience with MIS, and inclusion of more advanced cancers can define the learning curve. The purpose of this study was to determine the learning curve for R-VATS lobectomy by a surgeon with significant VATS lobectomy experience.
METHODS AND PROCEDURES: We retrospectively analyzed perioperative outcomes of consecutive patients who underwent robotic-assisted lobectomy by one surgeon at our institution between September 2010 and January 2015. Patients were grouped chronologically into five quintiles. Operative times, intraoperative estimated blood loss (EBL), perioperative complications, chest tube duration, hospital length of stay (LOS), and in-hospital mortality were compared among the quintiles.
RESULTS: A total of 287 patients were identified as having undergone R-VATS lobectomy by one surgeon between September 2010 and January 2015. Each of the 5 quintiles had emergency conversion rates of ≤5%. In-house mortality showed a decreasing trend with each subsequent quintile, while hospital LOS significantly decreased with subsequent quintiles. In addition, pulmonary and cardiac-related postoperative morbidity showed a decreasing trend with subsequent quintiles.
CONCLUSIONS: In the hands of a thoracic surgeon with significant conventional VATS lobectomy experience, a bi-phasic learning curve for R-VATS lobectomy was demonstrated by increased operative times with subsequent extension of R-VATS to more complicated cases after establishment of initial R-VATS lobectomy success (the 1st phase), while operative times, hospital LOS, and in-house mortality decreased with improved patient selection together with additional R-VATS experience (the 2nd phase). Based on our experience, overall surgical proficiency can be seen within approximately 114 cases, after which there is a significant decrease in adverse events. However, efficacy of MSLND for NSCLC is achieved after approximately 171 cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77567
Program Number: P678
Presentation Session: Poster (Non CME)
Presentation Type: Poster