Abstract
Objective
To investigate the key points in performing thoracoscopic anatomic pulmonary lesion
resection procedures, as well as analyze the characteristics of the learning curve
associated with the surgery.
Methods
We retrospectively collected clinical data and 1-year follow-up outcomes of children
diagnosed with congenital pulmonary airway malformation (CPAM) who underwent thoracoscopic
anatomic lesion resection in our hospital from January 2019 to December 2023. Perioperative
and short-term follow-up results were analyzed and surgical experiences and insights
were summarized. Furthermore, the cumulative sum (CUSUM) method was employed to plot
the learning curve of a single surgeon performing thoracoscopic anatomic resection,
and the impact of different phases on perioperative parameters and early follow-up
outcomes was investigated.
Results
This study included 154 patients undergoing thoracoscopic anatomic lesion resection.
Postoperative complications occurred in three patients (1.9%), and residual lesions
were identified in four cases (2.6%). When a single surgeon's procedural volume exceeded
39 cases, marking the transition to the proficiency phase, significant reductions
were observed in operative time, intraoperative blood loss, postoperative hospital
stay, and postoperative mechanical ventilation duration compared with the learning
phase (all p < 0.05). No significant differences were found in postoperative drainage volume and
chest tube duration.
Conclusion
The key to thoracoscopic anatomic lesion resection lies in identifying the lesion
boundaries and achieving precise dissection. Our study showed that this surgical approach
is relatively safe and feasible for children with CPAM, with favorable perioperative
and 1-year postoperative outcomes. Moreover, as surgeons progress to proficiency,
perioperative outcomes improve and the incidence of residual lesions decreases. However,
as a single-center study with a limited number of cases and due to a lack of long-term
follow-up data, the safety and efficacy of this technique still require further validation
through multi-center studies.
Keywords congenital malformation of lung airway - anatomical pulmonary lesion resection - learning
curve - children
