Learning curve of image-guided video-assisted thoracoscopic surgery for small pulmonary nodules: A prospective analysis of 30 initial patients


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Abstract

Objectives:The use of image-guided video-assisted thoracoscopic surgery for simultaneous localization and removal of small solitary pulmonary nodules in a hybrid operation room using C-arm cone-beam computed tomography is gaining momentum. We sought to assess the effect of the learning curve on procedural parameters and clinical outcomes of image-guided video-assisted thoracoscopic surgery for treating patients with small solitary pulmonary nodules.Methods:Clinical variables and treatment outcomes of the 30 initial patients with solitary pulmonary nodules who were treated with image-guided video-assisted thoracoscopic surgery at Chang Gung Memorial Hospital (Taiwan) were prospectively analyzed. Two sequential groups (groups I and II, n = 15 each) were compared with regard to localization time, radiation doses, and success rates. We used the Pearson's correlation coefficient to investigate the association between the surgical experience and the procedural time.Results:In the entire cohort, the median size of solitary pulmonary nodules on preoperative computed tomography images was 6 mm (interquartile range, 4.5-9 mm), and their median distance from the pleural surface was 10 mm (interquartile range, 5-15 mm). The median tumor depth-to-size ratio was 1.4 (interquartile range, 0.7-2.5). The clinical parameters were similar between the 2 groups. There was an inverse association between the surgical experience and the procedural time (Pearson's r = −0.6873; P < .001). A significant reduction in localization time (median, 24 vs 49 minutes, respectively; P < .001) and radiation exposure (median, 70.7 vs 224 mGy, respectively; P < .001) was noted in group II (late patients) compared with group I (early patients). Notably, the success rates in groups II and I were similar (93.3% vs 86.7%, respectively; P =. 876).Conclusions:Our data demonstrate a significant learning curve for image-guided video-assisted thoracoscopic surgery in the treatment of solitary pulmonary nodules as evidenced by decreased localization time and radiation exposure occurring with increased surgical experience.

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