title: The learning curve of the three-port two-instrument complete thoracoscopic lobectomy for lung cancer-A feasible technique worthy of popularization.
abstract: OBJECTIVE
  Cosmetic factors are important when considering minimally invasive surgery. For cosmetic improvement, a complete thoracoscopic lobectomy is accomplished via the three-port two-instrument (TPTI) technique. The resected specimen is removed without extending the port wounds. Only three wounds at 1.2 cm are used to finish the procedure.
  
  
  METHODS
  From June 2012 to December 2013, 60 patients with lung cancer were to undergo lobectomy and complete mediastinal lymph node dissection via the TPTI technique without an accessory wound. The initial 28 cases (learning curve group) and the latest 28 cases were compared to assess the learning curve.
  
  
  RESULTS
  Excluding four cases of conversion, there were 28 cases in each group. There were no differences between these two groups with respect to age, sex, tumor size, location of the lobectomy, mean blood loss, mean postoperative drainage time, and mean hospitalization time (p > 0.05). The mean surgery time significantly decreased, the mean number of lymph nodes removed significantly increased, and the postoperative stage was significantly more advanced in the latest 28 cases (p < 0.05). The conversion rate was similar in both groups.
  
  
  CONCLUSIONS
  Three-port complete thoracoscopic lobectomy with the two-instrument technique is feasible for lung cancer treatment. The length of the learning curve consisted of 28 cases. This TPTI technique should be popularized.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, E-DA Hospital, School of Medicine for International Students, I-Shou University, Kaohsiung, Taiwan, ROC. Electronic address: yujen.cheng@msa.hinet.net.
authors.forename: Yu-Jen
authors.initials: YJ
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000601:surgery*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008175:Lung Neoplasms / Q000601:surgery*; D008197:Lymph Node Excision / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000295:instrumentation / Q000379:methods*; D012372:ROC Curve; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: lung neoplasms; thoracic surgery; thoracoscopy; video-assisted