Learning Curve and Early Outcomes of Thoracoscopic Anatomical Lesion Resection for Congenital Pulmonary Airway Malformation in Children: A Single-Surgeon Experience

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 one-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 summarized surgical experiences and insights. 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 3 patients (1.9%), and residual lesions were identified in 4 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 to 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 one-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 a lack of long-term follow-up data, the safety and efficacy of this technique still require further validation through multi-center studies.

Publication History

Received: 22 May 2025

Accepted after revision: 08 December 2025

Accepted Manuscript online:
19 December 2025