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学科主题: 临床医学
题名:
Competence versus mastery: The time course for developing proficiency in video-assisted thoracoscopic lobectomy
作者: Li, Xiao1; Wang, Jun1; Ferguson, Mark K.2,3
刊名: JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
发表日期: 2014-04-01
DOI: 10.1016/j.jtcvs.2013.11.036
卷: 147, 期:4, 页:1150-1154
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Cardiac & Cardiovascular Systems ; Respiratory System ; Surgery
研究领域[WOS]: Cardiovascular System & Cardiology ; Respiratory System ; Surgery
关键词[WOS]: LEARNING-CURVE ; SURGERY ; EXPERIENCE
英文摘要:

Objectives: Thoracoscopic lobectomy has a vaguely defined learning curve for competency, whereas the development of proficiency has not been evaluated. We compared learning curves for 2 surgeons experienced in open lobectomy to define the learning process for thoracoscopic lobectomy.

Methods: The first 200 patients who underwent thoracoscopic lobectomy by 1 senior surgeon at 2 different institutions were evaluated. Data were abstracted from prospectively maintained databases. Learning curves were evaluated for operative time, blood loss, and postoperative length of stay by assessing elements of proficiency: efficiency (defined as decreasing values for these variables, assessed by Change-Point Analysis) and consistency (defined as the absence of outliers, evaluated by moving average). Conversion to open rates and complication rates were assessed.

Results: Surgeon A′s patients were younger than Surgeon B′s patients (57.4 vs 66.0 years; P<.001) and had fewer medical comorbidities. For Surgeons A and B, operation time (mean, 178 vs 180 minutes) efficiency was achieved at 157 and 108 cases, respectively, and blood loss (mean 181 vs 178 mL) efficiency was achieved at 126 and 139 cases, respectively. Conversion to open rates decreased between the first and second halves of the study (P<.001) despite expanding anatomic indications for a video-assisted thoracic surgery approach. Consistency was not reliably achieved for either surgeon for operating time or blood loss. Postoperative length of stay and complication rates did not change for either surgeon.

Conclusions: The learning curves for video-assisted thoracoscopic lobectomy were similar for both surgeons. Between 100 and 200 cases are required to achieve efficiency, and consistency requires even more cases.

语种: 英语
WOS记录号: WOS:000332772200016
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/55944
Appears in Collections:北京大学第二临床医学院_胸外科_期刊论文

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作者单位: 1.Univ Chicago, Dept Surg, Chicago, IL 60637 USA
2.Univ Chicago, Canc Res Ctr, Chicago, IL 60637 USA
3.Peking Univ, Peoples Hosp, Dept Thorac Surg, Beijing 100871, Peoples R China

Recommended Citation:
Li, Xiao,Wang, Jun,Ferguson, Mark K.. Competence versus mastery: The time course for developing proficiency in video-assisted thoracoscopic lobectomy[J]. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY,2014,147(4):1150-1154.
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