title: The influence of prior multiport experience on the learning curve for single-port thoracoscopic lobectomy: a multicentre comparative study†.
abstract: OBJECTIVE
  Competency in video-assisted thoracoscopic (VATS) lobectomy is estimated to be reached after the surgeon completes 50 cases. We wanted to explore the impact of competency in performing multiport VATS lobectomies on completing the needed number of single-port VATS.
  
  
  METHODS
  In a retrospective multicentre study, 6 individual surgeons (3 with previous competency in multiport VATS lobectomy and 3 without) submitted their first 50 cases of single-port VATS lobectomies. Extended and sublobar resections were excluded. Pre-, peri- and postoperative data were compared between the groups of surgeons. Chi-square and Wilcoxon's rank tests were used. The less experienced surgeons had previously attended dedicated training courses and visited with experts.
  
  
  RESULTS
  A total of 300 cases were included [150 in Group A (surgeons with previous experience performing multiport VATS) and 150 in Group B (surgeons without extensive experience performing multiport VATS)]. Surgeons in Group B performed significantly more elective open lobectomies during their learning curve period than surgeons of Group A (58 vs 1). Patients in Group B were older and had more risk factors. There were 3 in-hospital deaths (respiratory failure, sepsis and fatal stroke). There were no differences between the groups in operative time, intensive care unit admissions, hospital stay, total complications, tumour size or number of N2 stations explored. Only the duration of intercostal drainage (2 vs 3 days, 0.012), incidence of respiratory tract infections (1% vs 7%, P  = 0.002) and conversion rates (4% vs 12%, P  = 0.018) were better in Group A. Patients characteristics played a role in the development of respiratory infections and longer drainage times but not in the need for conversion.
  
  
  CONCLUSIONS
  Overall, postoperative outcomes during the learning curve period for single-port VATS lobectomies are not noticeably affected by previous multiport VATS experience. Less experienced surgeons were more selective in order to achieve competency (more lower lobectomies and more open operations). Competency in single-port VATS lobectomy can be acquired safely with adequate training and good case selection but will be achieved 'faster' with previous competency in multiport VATS lobectomy.
authors.affiliation: Thoracic Surgery Units, Sheffield Teaching Hospital, Sheffield, UK.
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Martin-Ucar
authors.affiliation: Unidad de Cirugia Toracica, Hospital Universitario Asturias, Oviedo, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Aragon
authors.affiliation: Unidad de Cirugia Toracica, Hospital Universitario Alicante, Alicante, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Bolufer Nadal
authors.affiliation: Unidad de Cirugia Toracica, Hospital Universitario Alicante, Alicante, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Galvez Munoz
authors.affiliation: Department of Thoracic Surgery, The University of Hong Kong Shenzhen Hospital, Shenzhen, China.
authors.forename: Qigang
authors.initials: Q
authors.lastname: Luo
authors.affiliation: Unidad de Cirugia Toracica, Hospital Universitario Asturias, Oviedo, Spain.
authors.forename: Itzel
authors.initials: I
authors.lastname: Perez Mendez
authors.affiliation: Department of Thoracic Surgery, University Hong Kong, Hong Kong, China.
authors.forename: Alan D L
authors.initials: ADL
authors.lastname: Sihoe
authors.affiliation: Thoracic Surgery Units, Sheffield Teaching Hospital, Sheffield, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Socci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D059032:Learning Curve; D008875:Middle Aged; D011013:Pneumonectomy / Q000193:education / Q000706:statistics & numerical data; D012189:Retrospective Studies; D066231:Surgeons / Q000193:education / Q000706:statistics & numerical data; D020775:Thoracic Surgery, Video-Assisted / Q000193:education / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
keywords: Surgical outcomes ; Thoracoscopy; Training 