Learning Curve for Totally Thoracoscopic Lobectomy in Treating Pediatric
Patients with Congenital Lung Malformation
Abstract
Abstract Purpose: To evaluate our learning curve of pediatric totally
thoracoscopic lobectomy (TTL), we review the safety and efficiency of
our initial experiences with TTL on pediatric patients with congenital
lung malformation. Materials and Methods: This was a retrospective study
of all the pediatric patients undergoing TTL between March 2011 and
January 2017. Cumulative summation (CUSUM) analysis of operative time
(OT) was used. Results: One hundred and three patients were
retrospectively analyzed and were divided chronologically into two
phases, ascending phase (A) and descending phase (B), through CUSUM of
OT. Phases A and B comprised 52 and 51 cases, respectively. OT decreased
significantly from phases A to B (P < 0.05). No significant
differences were observed in the demographic factors (except for age and
body weight) and the conversion or the complication rates between the
two phases. Six cases were converted to open surgery (5.8%). Four
conversions occurred within the first third of the series and two in the
last third. There were no mortalities. Conclusions: Repeated
standardized training play a role in overcoming the learning curve for
totally thoracoscopic lobectomy in children, and CUSUMOT indicates that
the learning curve of around 52 cases is required in our institute.