title: Development of a video-assisted thoracoscopic lobectomy program in a single institution: results before and after completion of the learning curve.
abstract: BACKGROUND
  The development of a video assisted thoracic surgery lobectomy (VATS-L) program provides a dedicated surgical team with a recognized learning curve (LC) of 50 procedures. We analyse the results of our program, comparing the LC with subsequent cases.
  
  
  METHODS
  From June 2012 to March 2015, we performed n = 146 VATS major pulmonary resections: n = 50 (Group A: LC); n = 96 (Group B). Pre-operative mediastinal staging followed the National Comprehensive Cancer Network guidelines. All procedures were performed using a standard anterior approach to the hilum; lymphadenectomy followed the NCCN recommendations. During the LC, VATS-L indication was reserved to clinical stages I, therefore evaluated case by case.
  
  
  RESULTS
  Mean operative time was 191 min (120-290) in Group A and 162 min (85-360) in Group B (p <0,01). Pathological T status was similar between two Groups. Lymphadenectomy included a mean of 5.8 stations in Group A and 6.6 in Group B resulting in: pN0 disease: Group A n = 44 (88 %), Group B n = 80 (83.4 %); pN1: Group A n = 3 (6 %), Group B n = 8 (8.3 %); pN2: Group A n = 3 (6 %), Group B n = 8 (8.3 %). Conversion rate was: 8 % in group A (n = 4 vascular injuries); 1.1 % in Group B (n = 1 hilar lymph node disease). We registered n = 6 (12 %) complications in Group A, n = 10 (10.6 %) in Group B. One case (1.1 %) of late post-operative mortality (90 days) was registered in Group B for liver failure. Mean hospital stay was 6.5 days in Group A and 5.9 days in Group B.
  
  
  CONCLUSIONS
  We confirm the effectiveness of a VATS-L program with a learning curve of 50 cases performed by a dedicated surgical team. Besides the LC, conversion rate falls down, lymphadenectomy become more efficient, indications can be extended to upper stages.
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Alessandro
authors: A
authors: Gonfiotti
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy. stefanobongiolatti@gmail.com.
authors: Stefano
authors: S
authors: Bongiolatti
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Sara
authors: S
authors: Borgianni
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Roberto
authors: R
authors: Borrelli
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Massimo O
authors: MO
authors: Jaus
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Leonardo
authors: L
authors: Politi
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Giorgia
authors: G
authors: Tancredi
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Domenico
authors: D
authors: Viggiano
authors: Thoracic Surgery Unit, University Hospital Careggi, Largo Brambilla, 1, 50134, Florence, Italy.
authors: Luca
authors: L
authors: Voltolini
mesh_terms: D000368:Aged; D061887:Conversion to Open Surgery; D005260:Female; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008197:Lymph Node Excision / Q000379:methods; D008297:Male; D008482:Mediastinum; D008875:Middle Aged; D009367:Neoplasm Staging; D061646:Operative Time; D011013:Pneumonectomy / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
keywords: Education; Learning curve; Minimal invasive surgery; Thoracic surgery; VATS lobectomy