Masato KANZAKI, Shota MITSUBOSHI, Tamami ISAKA, Takako MATSUMOTO, Hiroe AOSHIMA, Hideyuki MAEDA, Hiroaki SHIDEI

Effects of robot- and video-assisted thoracoscopic lobectomy experiences on the learning curve of lobectomy

Background: This study aims to investigate the effects of robot- and videoassisted thoracoscopic lobectomy on the learning curve of lobectomy. Methods: Between September 2013 and February 2020, the first 68 consecutive patients (28 males, 40 females; median age: 71 years; range, 33 to 86 years) who were operated for lung malignancies and scheduled for robot-assisted thoracoscopic lobectomy were retrospectively analyzed. The characteristics of the patients and operative data were analyzed, and the operation times of the first 51 cases of video-assisted thoracoscopic lobectomy were compared with those of robot-assisted thoracoscopic lobectomy performed by a single surgeon. Results: Of the patients, 62 had primary lung cancer and six had metastatic lung tumors. The majority of primary lung cancer patients (87.1%) had an adenocarcinoma. The most common clinical stage was IA1 (30.9%). There was no emergent conversion to thoracotomy in any of the patients. The median operation time was 223.5 min, and console time was 151 min. The most common complication was an air leak. All patients were alive. Compared to video-assisted thoracoscopic lobectomy, the median operation time was significantly longer in the robot-assisted thoracoscopic lobectomy group (p=0.0002). Similar to the operation time learning curve of the video-assisted thoracoscopic surgery group, the operation time learning curve of the robotassisted thoracoscopic surgery group increased from the first to ninth case (Phase 1), plateaued from the 10th t o 14th c ase ( Phase 2 ), and decreased from the 15th case (Phase 3). There was a statistically significant decrease in the operation time between Phase 1 and Phase 3 (p=0.0063). Conclusion: The results of robot-assisted thoracoscopic lobectomy by a single surgeon show that this surgery has a longer operation time, but the perioperative outcomes are satisfactory. The learning curve of this surgery may be gradual for experienced video-assisted thoracoscopic surgeons.

Robot ve video yardımlı torakoskopik lobektomi deneyimlerinin lobektominin öğrenme eğrisi üzerine etkileri

Amaç: Bu çalışmada robot ve video yardımlı torakoskopik lobektominin, lobektomi öğrenme eğrisi üzerine etkileri araştırıldı. Çalışma planı: Eylül 2013 - Şubat 2020 tarihleri arasında akciğer maligniteleri nedeniyle ameliyat edilen ve robot yardımlı torakoskopik lobektomi yapılması planlanan ilk 68 ardışık hasta (28 erkek, 40 kadın; medyan yaş: 71 yıl; dağılım, 33-86 yıl) retrospektif olarak incelendi. Hastaların özellikleri ve ameliyat verileri analiz edildi ve video yardımlı torakoskopik lobektomi yapılan ilk 51 hastanın ameliyat süreleri, tek bir cerrah tarafından yapılan robot yardımlı torakoskopik lobektomi yapılanlarınki ile karşılaştırıldı. Bulgular: Hastaların 62’sinde primer akciğer kanseri ve altısında metastatik akciğer tümörleri mevcuttu. Primer akciğer kanserli hastaların büyük bir kısmında (%87.1) adenokarsinom vardı. En sık görülen klinik evre IA1 idi (%30.9). Hastaların hiçbirinde acil torakotomiye dönülmedi. Medyan ameliyat süresi 223.5 dk ve konsol süresi 151 dk idi. En sık görülen komplikasyon hava kaçağı idi. Hastaların tümü sağ kaldı. Video yardımlı torakoskopik lobektomiye kıyasla, medyan ameliyat süresi, robot yardımlı torakoskopik lobektomi grubunda anlamlı düzeyde daha uzundu (p=0.0002). Video yardımlı torakoskopik cerrahinin ameliyat süresi öğrenme eğrisine benzer şekilde, robot yardımlı torakoskopik cerrahinin ameliyat süresi öğrenme eğrisi birinci ila dokuzuncu olgu arasında artış gösterdi (Faz 1), 10 ila 14. olgu arasında plato çizdi (Faz 2) ve 15. olgudan sonra düşüşe geçti (Faz 3). Faz 1 ve Faz 3 arasında ameliyat süresinde istatistiksel olarak anlamlı düzeyde bir düşüş izlendi (p=0.0063). Sonuç: Tek bir cerrah tarafından yapılan robot yardımlı torakoskopik lobektomi sonuçları bu cerrahinin ameliyat süresinin daha uzun olduğunu, ancak perioperatif sonuçların tatmin edici olduğunu göstermektedir. Bu cerrahinin öğrenme eğrisi, video yardımlı torakoskopik cerrahi konusunda deneyimli cerrahlar için kademeli olabilir.

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