The learning curve of video-assisted thoracoscopic sleeve lobectomy in a high-volume pulmonary center

Objectives To evaluate the time course and caseload required to achieve proficiency by plotting the learning curve of video-assisted thoracoscopic sleeve lobectomy. Methods We reviewed 127 cases of video-assisted thoracoscopic sleeve lobectomy by a single surgeon at Shanghai Pulmonary Hospital to evaluate its learning curve using the cumulative sum (CUSUM) analysis. The changes of perioperative outcomes were assessed. Results The inflection points of the CUSUM curve were around case 30 and 90, according to which 3 phases were identified: Phase I, Phase II, and Phase III. Significant downtrends were observed regarding operative time (Phase I, 194 [173-233 minutes] vs Phase II, 172 [142-215 minutes] vs Phase III, 138 [117-164 minutes], P
Graphical abstract 30 cases are needed to lay the technical foundation and 90 cases are required to achieve proficiency. Significant improvements concerning the perioperative outcomes were observed as the learning curve developed. CUSUM, Cumulative sum; OT, operative time.