Comparative evaluation of the learning curve of lobectomies performed by open and video-assisted accesses

Objective. Comparative evaluation of the duration of training and immediate results of treatment with videothoracoscopic (VATS) lobectomy via two-port access and open lobectomy in novice surgeons. Material and methods. The study included 118 surgical interventions performed in the thoracic department of AU RKOD of the Ministry of Health of the Chuvash Republic from January 2021 to February 2023. For comparative evaluation of the two learning curves, the operations were divided into two groups: the first group included VATS lobectomies performed via two-port access by a surgeon with initial zero experience in performing such operations (n=50) but with more than 5 years of experience in thoracic oncology; the second group included surgical interventions (n=68) performed by surgeons with less than 5 years of experience in thoracic surgery. Results. Evaluation of the learning curves showed that 31 operations were required to master VATS and 29 for open lobectomies, after which the duration of operations did not change significantly. The duration of surgery was longer in the VATS group (190 (150—230) min vs. 150 (122.5—175) min; p=0.0004). Blood loss was not statistically different in both groups (VATS 100 (50—200) ml, open lobectomy 75 (50—100) ml; p=0.42). The duration of drainage was shorter in the VATS group (6 (4—7) days vs. 7 (6—8) days; p=0.0000). The number of removed lymph nodes was higher in the thoracoscopic lobectomy group (11.5 (8.5—16) vs. 8.5 (7—12.5); p=0.01). Conclusion. The learning curves for VATS lobectomy and thoracotomy lobectomy are comparable. The level of competence and safety for performing standard lobectomies is achieved on average for both techniques after 30 operative procedures. However, significantly more operations are required to achieve mastery and to perform combined lobectomies.