Learning curve and established phase for uniportal VATS lobectomies: The Papworth experience

Background: Uniportal video-assisted thoracoscopy (VATS) has increasingly gained importance in thethoracic surgery scenario. The use of this technique can reduce postoperative pain and length of stay andgives the surgeon the same operative perspective as open surgery.Methods: We retrospectively analysed the data of 73 patients who underwent uniportal VATS lobectomiesfrom November 2014 to December 2015 in our institution. We divided the patients in two groups (group 1:first 30 patients vs. group 2: established phase, 43 patients) to compare and evaluate the data regarding thelearning curve. To explore evolution of learning curve, data were plotted to calculate Spearman's Rank-OrderCorrelation. R (version 3.2.3) was used for statistical analysis.Results: The median age was 69.9 (group 1) and 68.8 (group 2) years. Mean operative time was 84.9±33.0(group 1) and 84.8±31.5 (group 2) minutes. The conversion rate was 13.3% in group 1 vs. 9.3% in group 2,showing a significant learning reduction (rho=0.590). Overall morbidity rate was 15.1%. The most commoncomplication consisted in prolonged air leak. Interpolation line of complications showed a significantdecrease due to learning curve (rho=0.676). The median length of stay was 4 days in group 1 vs. 3 days ingroup 2. The 30-day mortality was 3.3% in group 1 and 0% in group 2.Conclusions: The comparison between the groups showed that the median length of stay, operativetime, conversion rate and 30-day mortality statistically significantly improved in the established phase. Also,complications like prolonged air leak were decreasing in the established phase. In conclusion, the uniportalVATS lobectomy technique can be performed safely from experienced surgeons without major complicationsand with an acceptable mortality rate.