The safe transition from open to thoracoscopic lobectomy: a 5-year experience.
BACKGROUND
We hypothesized that established thoracic surgeons without formal minimally invasive training can learn thoracoscopic lobectomy without compromising patient safety or outcome.


METHODS
Data were retrospectively collected on patients who underwent pulmonary lobectomy at a single health system between August 1, 2003, and April 1, 2008. Age, sex, pulmonary function tests, preoperative and postoperative stages, pathologic diagnosis, anatomic resection, extent of lymph node sampling, surgical technique and duration, complications, blood loss, transfusion requirement, chest tube duration, length of hospital stay, 30-day readmission, and mortality rate were examined. The percentage of patients who underwent thoracoscopic lobectomy and their outcomes were then compared among three chronologic cohorts.


RESULTS
Three hundred sixty-four patients underwent pulmonary lobectomy (239 open; 99 thoracoscopic; 26 thoracoscopic converted to open). Baseline characteristics, staging, pathologic diagnosis, and anatomic resections were similar in the early, middle, and late cohorts. The percentage of thoracoscopic lobectomies increased from 16% to 49%, whereas open lobectomy decreased from 81% to 42% (p < 0.0001). The complication rate remained constant with the exception of air leaks lasting more than 7 days (9% versus 10% versus 2%; p = 0.02). Hospital length of stay (6 versus 5 versus 4 days; p < 0.0001) and chest tube duration (4 versus 3 versus 3 days; p < 0.0001) decreased and operative duration increased as more thoracoscopic lobectomies were performed. Blood loss, transfusion requirement, 30-day readmission, and 1-year survival were not significantly different among chronologic cohorts.


CONCLUSIONS
Established thoracic surgeons can safely incorporate thoracoscopic lobectomy with no increase in morbidity or mortality.
Seder
Christopher W
CW
Department of Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA.
Hanna
Kenny
K
Lucia
Victoria
V
Boura
Judith
J
Kim
Sang W
SW
Welsh
Robert J
RJ
Chmielewski
Gary W
GW
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods / Q000401:mortality; D007902:Length of Stay; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000401:mortality; D011013:Pneumonectomy / Q000379:methods* / Q000401:mortality; D011336:Probability; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013903:Thoracic Surgery / Q000592:standards / Q000639:trends; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods* / Q000401:mortality; D013906:Thoracoscopy / Q000379:methods / Q000401:mortality; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome