title: Cusum analysis for learning curve of videothoracoscopic lobectomy.
abstract: BACKGROUND
  Video assisted thoracoscopic (VATS) lobectomy has a demanding learning curve due to its technical complexity and risk of uncontrollable bleeding. We investigated the case number required for gaining technical proficiency by applying cumulative sum analysis on initial VATS lobectomy operations of a single surgeon.
  
  
  METHODS
  CALGB definition was used for the definition of VATS lobectomy. The data of the initial cases evaluated and cumulative sum (CUSUM) analysis was applied to duration of the operations and length of hospital stay.
  
  
  RESULTS
  Fifty-eight patients underwent VATS lobectomy. Of those 51 were malignant and 7 were benign. Fifty-five of the procedures were lobectomy, 2 were inferior bi-lobectomy and 1 was left upper lobectomy with chest wall resection. CUSUM analysis reached to proficiency at 27 cases for duration of the operations.
  
  
  CONCLUSIONS
  The length of learning curve depends on previous experience of the surgeon on open lobectomy and simpler VATS operations, potential number of VATS lobectomy cases and VATS capability of the surgeon. Depending on these factors, it is possible to obtain technical proficiency with an inferior number of procedures compared with existing literature (50-200).
authors.affiliation: Medical Faculty of Çukurova University. Department of Thoracic Surgery. Tip Fakültesi, Göğüs Cerrahisi AD., 01330 Sariçam, Adana, Turkey ,.
authors.forename: Suat
authors.initials: S
authors.lastname: Gezer
authors.affiliation: Medical Faculty of Çukurova University. Department of Thoracic Surgery. Adana, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Avcı
authors.affiliation: Medical Faculty of Çukurova University. Department of Anesthesiology and Reanimation. Adana, Turkey.
authors.forename: Mediha
authors.initials: M
authors.lastname: Türktan
keywords: Cumulative sum analysis; Technical proficiency; Videothoracoscopic lobectomy