Optimizing the uniportal video-assisted thoracic surgery learning curve in major lung resection

Background: As uniportal video-assisted thoracic surgery (VATS) becomes a more popular approach to lung cancer resection, establishing safe and efficacious training programmes becomes a priority. Here we examine a personalized method of training on a national trainee's learning curve in an UK center. Methods: A retrospective analysis was performed of prospectively collected data from the first 34 consecutive cases of uniportal VATS anatomical lung resection a single trainee performed. The cases were from their first 7 months of uniportal VATS training with a trainer with advanced knowledge of the technique. Specific to the training technique was that cases were not selected; the consultant trainer was available in theatre throughout all cases and learning was reinforced using post-operative video review. Results: Of 34 cases performed, the trainer was required to scrub in for 20, six at an early stage. All patients survived to discharge, there were two conversions across the entire cohort, one for intraoperative bleeding. Using a cumulative sum (CUSUM) analysis a significant reduction in mean operating time was seen from the first 14 cases to the latter 20 cases. Conclusions: Teaching in uniportal VATS can be done outside of ultra-high-volume centers with a similarly short learning curve when traditional teaching methods are modified.