초록접수 현황
| 15F-130 | 구연 발표 |
Learning Curve of Single Incision Thoracoscopic Surgery for Primary Spontaneous Pneumothorax
양희철¹, 김소희², 조석기³, 김관민³, 전상훈³
국립암센터 폐암센터 흉부외과¹, 국립암센터 바이오매트릭연구과², 서울대학교 의과대학 분당서울대학교병원 흉부외과학교실³
Background : Single incision thoracoscopic surgery (SITS) requires accumulative time to achieve satisfactory technical skills. The aim of this study was to evaluate the SITS learning curves for primary spontaneous pneumothorax (PSP) patients.
Methods : This study included 274 consecutive patients who underwent surgery for PSP by a single operator between May 2011 and February 2014. During this period, SITS was applied as a routine approach. Learning curves were made by cumulative sum (Cusum) method using the number of cases and four surgical technique related factors including operation time, postoperative complication, non-SITS rate, and ipsilateral recurrence of PSP.
Results : Among 274 patients, 16 patients who had previous 3-port wound scar or inadequate chest tube site before surgery were not good indications for SITS. SITS was tried in 258 patients and performed successfully in 251 patients. For the successful SITS patients, the mean age was 22.9±8.1 years, the mean operation time was 65.6±22.2 minutes, the mean chest tube indwelling time was 1.5±1.1 days, and the mean postoperative hospital stay was 1.7±1.1 days. Mean operation time significantly decreased from 84.0 minutes to 47.6 minutes comparing the initial 6 months and the last 6 months operated patients. The Cusum technique revealed that after 92 cases, the proportion of the number of patients who had operation time less than 70 minutes began to be more than 50%. Postoperative complication rate was maintained fewer than 5% after 57 cases. Non-SITS rate during the study period was achieved fewer than 5% after 112 cases. Ipsilateral PSP recurrence rate was stably maintained below 8% after 102 cases.
Conclusion : Although PSP is the most applicable for the SITS beginner, at least 100 cases of experience is needed to achieve optimal technical level.
Methods : This study included 274 consecutive patients who underwent surgery for PSP by a single operator between May 2011 and February 2014. During this period, SITS was applied as a routine approach. Learning curves were made by cumulative sum (Cusum) method using the number of cases and four surgical technique related factors including operation time, postoperative complication, non-SITS rate, and ipsilateral recurrence of PSP.
Results : Among 274 patients, 16 patients who had previous 3-port wound scar or inadequate chest tube site before surgery were not good indications for SITS. SITS was tried in 258 patients and performed successfully in 251 patients. For the successful SITS patients, the mean age was 22.9±8.1 years, the mean operation time was 65.6±22.2 minutes, the mean chest tube indwelling time was 1.5±1.1 days, and the mean postoperative hospital stay was 1.7±1.1 days. Mean operation time significantly decreased from 84.0 minutes to 47.6 minutes comparing the initial 6 months and the last 6 months operated patients. The Cusum technique revealed that after 92 cases, the proportion of the number of patients who had operation time less than 70 minutes began to be more than 50%. Postoperative complication rate was maintained fewer than 5% after 57 cases. Non-SITS rate during the study period was achieved fewer than 5% after 112 cases. Ipsilateral PSP recurrence rate was stably maintained below 8% after 102 cases.
Conclusion : Although PSP is the most applicable for the SITS beginner, at least 100 cases of experience is needed to achieve optimal technical level.
책임저자: 양희철
국립암센터 폐암센터 흉부외과
연락처 : 양희철, Tel: 031-920-1705 , E-mail : yang@ncc.re.kr
