Zentralbl Chir 2016; 141 - P50
DOI: 10.1055/s-0036-1587570

VATS lobectomy: learning curve in a setting of experienced VATS surgery

G Seebacher 1, M Brndiar 2, J Tripsky 2, T Bohanes 2, E Stubenberger 2
  • 1Abt. für Allgemein- und Thoraxchirurgie, Univ. Klinikum Krems; Karl Landsteiner Institut für Klinische Chirurgie
  • 2Abt. für Allgemein- und Thoraxchirurgie, Univ. Klinikum Krems

Background: VATS lobectomy is widely accepted as a standard procedure for the treatment of early stage lung cancer nowadays, but the method is not implemented that widely. A lot of colleagues are afraid of taking this hurdle. The same situation could be observed at our department. We visited several workshops to get instructions how to begin until we really made it.

Material and Methods: Four thoracic surgeons with a minimum of 8 years of experience, well trained in VATS surgery but having almost no experience in VATS lobectomy started the program at the same time. One senior surgeon with 80 VATS lobectomies done worked as a supervisor. After the period of January 2014 until April 2016 we retrospectively analyzed our performance.

Results: Within the period of 16 months we had done 117 lobectomies, 53 were done with anterolateral incision, 64 by VATS access (54,7%). We had to convert for 3 times; first due to a recurrent bleeding from a pulmonary segmental vein, second due to pleural adhesions and third due to a patient with severe COPD with a lack of collapse of the lung. No mortality was seen in both groups. The mean operating time was 173 minutes for VATS access (minimum: 106 min, maximum: 333 min) and 129 for open access (minimum: 63 min, maximum 253 min). As well as in several studies reported there was a trend for less pain and earlier discharge in the VATS group. Concerning operation time there was a reduction seen in 3 of the four surgeons in the first half of operations compared to the second: 178,3 min vs. 170 min (-4,5%, n = 25), 203 min vs. 179,3 min (-11,7%, n = 8), 202,4 vs. 171,8 min (-15,2%, n = 10). The fourth started faster (148,9 min), but lost time within the observation period (162 min) (+8,8% %, n = 20).

Conclusion: VATS lobectomy is much easier to learn than expected. Substantial experience of endoscopic lung surgery prior to VATS lobectomy was helpful. Complications could be kept very low despite the fact, that four guys started the same time.