Abstract OBJECTIVES Uniportal video-assisted thoracoscopic surgery (UniVATS) is widely used as a minimally invasive thoracic operation. The goal of our study was to analyse the effect of long-term experience with the UniVATS lobectomy on the learning curve. METHODS The learning curves were quantitatively evaluated by the unadjusted cumulative sum, and they were segmented using joinpoint linear regression analysis. The variables were compared between subgroups using trend analysis, and linear regression analysis was applied to correlate clinical characteristics at different stages of the learning curve with the duration of the operation. RESULTS The learning curve for the UniVATS lobectomy can be divided into 3 phases of proficiency at ∼200–300 procedures, with a fourth phase as the number of procedures increases. The 1st–52nd, 52nd–156th, 156th–244th and 244th–538th procedures comprised the preliminary learning stage, preliminary proficiency stage, proficiency stage and advanced proficiency stage, respectively. Surgical outcomes and their variability between stages improved with increasing case numbers, with the most significant addition of an auxiliary operating port and conversions. In multivariable analysis, as stages progressed, influences other than surgical experience increased the operative time, with male and extensive pleural adhesions in the preliminary proficiency stage; male and incomplete pulmonary fissures in the proficiency stage; and male, extensive pleural adhesions and incomplete pulmonary fissures in the advanced proficiency stage. CONCLUSIONS As the number of procedures increases, there may be 4 different proficiency stages in the UniVATS lobectomy learning curve. The surgeon enters the fourth stage at approximately the 244th procedure. Moreover, at stage 4, the perioperative indicators tend to stabilize, and influences other than surgical experience become more significant.
In the originally published version of this manuscript, there were errors in the figure in the Abstract. The text in the “Key question” box should read “Are gelatine sealing sheets more effective than fibrin sealing sheets in preventing surgical adhesions?” instead of “How do outcomes of ONCAB, OPCAB, PC and HCR compare in the setting of multivessel coronary artery disease?”. The text in the “Key finding(s)” box should read “The gelatine sealing sheets are more effective in preventing surgical adhesions than the fibrin sealing sheets.” Instead of “Whereas PCI had favourable early outcomes, surgical approaches were associated with lower risk of MACCE beyond 1year.” The text in the “Take-home message” box should read
OBJECTIVES Robot-assisted coronary bypass surgery has been developed as a less invasive alternative for conventional CABG enhancing postoperative recovery, patient satisfaction and early discharge to home destination. Furthermore, it may provide a basis for hybrid coronary revascularisation. To determine the feasibility of this procedure, we compared robot-assisted with conventional off-pump CABG. METHODS All consecutive patients undergoing a robot-assisted LIMA to LAD procedure were compared to consecutive patients undergoing conventional off-pump CABG for single-vessel disease from October 2016 to July 2019. Primary outcome was discharge to home destination within five days after surgery. Secondary outcomes were total hospital stay, reoperations within 48 hours, transfusion, atrial fibrillation, 30-day mortality, and quality of life one month after surgery. A propensity-matched cohort was composed to correct for possible confounders. RESULTS One hundred seven robot-assisted CABG patients were compared to 194 conventional off-pump CABG. Primary outcome was reached in 51% of the robot-assisted group versus 19% of the conventional off-pump group (p < 0.01). Median postoperative hospital stay was five days in the robot-assisted group versus seven days in the conventional off-pump group (p < 0.01). Other secondary outcomes did not differ significantly between groups, and quality of life one month after surgery was equal. The results after propensity matching were similar. CONCLUSION Early discharge to home destination is more frequent in robot-assisted CABG than in conventional off-pump CABG patients, with no difference in health-related quality of life. Therefore, this approach may reduce healthcare resources and provide a solid basis for hybrid coronary revascularisation.
