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Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve
BACKGROUND: The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases. METHODS: From June 2012 to March 2015,...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974708/ https://www.ncbi.nlm.nih.gov/pubmed/27496022 http://dx.doi.org/10.1186/s13019-016-0526-8 |
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author | Gonfiotti, Alessandro Bongiolatti, Stefano Borgianni, Sara Borrelli, Roberto Jaus, Massimo O. Politi, Leonardo Tancredi, Giorgia Viggiano, Domenico Voltolini, Luca |
author_facet | Gonfiotti, Alessandro Bongiolatti, Stefano Borgianni, Sara Borrelli, Roberto Jaus, Massimo O. Politi, Leonardo Tancredi, Giorgia Viggiano, Domenico Voltolini, Luca |
author_sort | Gonfiotti, Alessandro |
collection | PubMed |
description | BACKGROUND: The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases. METHODS: From June 2012 to March 2015, we performed n = 146 VATS major pulmonary resections: n = 50 (Group A: LC); n = 96 (Group B). Pre-operative mediastinal staging followed the National Comprehensive Cancer Network guidelines. All procedures were performed using a standard anterior approach to the hilum; lymphadenectomy followed the NCCN recommendations. During the LC, VATS-L indication was reserved to clinical stages I, therefore evaluated case by case. RESULTS: Mean operative time was 191 min (120-290) in Group A and 162 min (85-360) in Group B (p <0,01). Pathological T status was similar between two Groups. Lymphadenectomy included a mean of 5.8 stations in Group A and 6.6 in Group B resulting in: pN0 disease: Group A n = 44 (88 %), Group B n = 80 (83.4 %); pN1: Group A n = 3 (6 %), Group B n = 8 (8.3 %); pN2: Group A n = 3 (6 %), Group B n = 8 (8.3 %). Conversion rate was: 8 % in group A (n = 4 vascular injuries); 1.1 % in Group B (n = 1 hilar lymph node disease). We registered n = 6 (12 %) complications in Group A, n = 10 (10.6 %) in Group B. One case (1.1 %) of late post-operative mortality (90 days) was registered in Group B for liver failure. Mean hospital stay was 6.5 days in Group A and 5.9 days in Group B. CONCLUSIONS: We confirm the effectiveness of a VATS-L program with a learning curve of 50 cases performed by a dedicated surgical team. Besides the LC, conversion rate falls down, lymphadenectomy become more efficient, indications can be extended to upper stages. |
format | Online Article Text |
id | pubmed-4974708 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-49747082016-08-06 Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve Gonfiotti, Alessandro Bongiolatti, Stefano Borgianni, Sara Borrelli, Roberto Jaus, Massimo O. Politi, Leonardo Tancredi, Giorgia Viggiano, Domenico Voltolini, Luca J Cardiothorac Surg Research Article BACKGROUND: The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases. METHODS: From June 2012 to March 2015, we performed n = 146 VATS major pulmonary resections: n = 50 (Group A: LC); n = 96 (Group B). Pre-operative mediastinal staging followed the National Comprehensive Cancer Network guidelines. All procedures were performed using a standard anterior approach to the hilum; lymphadenectomy followed the NCCN recommendations. During the LC, VATS-L indication was reserved to clinical stages I, therefore evaluated case by case. RESULTS: Mean operative time was 191 min (120-290) in Group A and 162 min (85-360) in Group B (p <0,01). Pathological T status was similar between two Groups. Lymphadenectomy included a mean of 5.8 stations in Group A and 6.6 in Group B resulting in: pN0 disease: Group A n = 44 (88 %), Group B n = 80 (83.4 %); pN1: Group A n = 3 (6 %), Group B n = 8 (8.3 %); pN2: Group A n = 3 (6 %), Group B n = 8 (8.3 %). Conversion rate was: 8 % in group A (n = 4 vascular injuries); 1.1 % in Group B (n = 1 hilar lymph node disease). We registered n = 6 (12 %) complications in Group A, n = 10 (10.6 %) in Group B. One case (1.1 %) of late post-operative mortality (90 days) was registered in Group B for liver failure. Mean hospital stay was 6.5 days in Group A and 5.9 days in Group B. CONCLUSIONS: We confirm the effectiveness of a VATS-L program with a learning curve of 50 cases performed by a dedicated surgical team. Besides the LC, conversion rate falls down, lymphadenectomy become more efficient, indications can be extended to upper stages. BioMed Central 2016-08-05 /pmc/articles/PMC4974708/ /pubmed/27496022 http://dx.doi.org/10.1186/s13019-016-0526-8 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Gonfiotti, Alessandro Bongiolatti, Stefano Borgianni, Sara Borrelli, Roberto Jaus, Massimo O. Politi, Leonardo Tancredi, Giorgia Viggiano, Domenico Voltolini, Luca Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve |
title | Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve |
title_full | Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve |
title_fullStr | Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve |
title_full_unstemmed | Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve |
title_short | Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve |
title_sort | development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4974708/ https://www.ncbi.nlm.nih.gov/pubmed/27496022 http://dx.doi.org/10.1186/s13019-016-0526-8 |
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