Top

Surgical Endoscopy

Published in:

01-10-2017

Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve

Authors: Samina Park, Eung Re Kim, Yoohwa Hwang, Hyun Joo Lee, In Kyu Park, Young Tae Kim, Chang Hyun Kang

Published in: Surgical Endoscopy | Issue 10/2017

Abstract

Background

Video-assisted thoracic surgery (VATS) pulmonary resection in children is a technically demanding procedure that requires a relatively long learning period. This study aimed to evaluate the serial improvement of quality metrics according to case volume experience in pediatric VATS pulmonary resection of congenital lung malformation (CLM).

Methods VATS anatomical resection in CLM was attempted in 200 consecutive patients. The learning curve for the operative time was modeled by cumulative sum analysis. Quality metrics were used to measure technical achievement and efficiency outcomes.

Results The median operative time was 95 min. The median length of hospital stay and chest tube indwelling time was 4 and 2 days, respectively. The improvement of operation time was observed persistently until 200 cases. However, two cut-off points, the 50th case and 110th case, were identified in the learning curve for operative time, and the 110th case was the turning point for stable outcomes with short operation time. Significant reduction of length of hospital stay and chest tube indwelling time was observed after 50 cases (p = .002 and p = .021, respectively). The complication rate decreased but continued at a low rate for entire study period and the interval decrease was not statistically significant. Conversion rate decreased significantly (p = .001), and technically challenging procedures were performed more frequently in later cases.

Conclusions Improvements of quality metrics in operation time, conversion rate, length of hospital stay, and chest tube indwelling time were observed in proportion to case volume. Minimum experience of 50 is necessary for stable outcomes of pediatric VATS pulmonary resection.

Horak E, Bodner J, Gassner I, Schmid T, Simma B, Grässl G et al (2003) Congenital cystic lung disease: diagnostic and therapeutic considerations. Clin Pediatr (Phila) 42:251–261CrossRef

Laberge JM, Puligandla P, Flageole H (2005) Asymptomatic congenital lung malformations. Semin Pediatr Surg 14:16–33CrossRefPubMed

Lawal TA, Gosemann JH, Kuebler JF, Gluer S, Ure BM (2009) Thoracoscopy versus thoracotomy improves midterm musculoskeletal status and cosmesis in infants and children. Ann Thorac Surg 87:224–228CrossRefPubMed

Bal S, Elshershari H, Celiker R, Celiker A (2003) Thoracic sequels after thoracotomies in children with congenital cardiac disease. Cardiol Young 13:264–267PubMed

Reismann M, Gossner J, Glueer S, Schwerk N, Ure B, Metzelder M (2012) Thoracoscopic resection of congenital pulmonary malformations in infants: is the feasibility related to the size of the lesion? World J Pediatr 8:272–274CrossRefPubMed

Metzelder ML, Kuebler JF, Reismann M, Lawal TA, Glueer S, Ure B (2009) Prior thoracic surgery has a limited impact on the feasibility of consecutive thoracoscopy in children: a prospective study on 228 procedures. J Laparoendosc Adv Surg Tech A 19(Suppl 1):S63–S66CrossRefPubMed

Seong YW, Kang CH, Kim JT, Moon HJ, Park IK, Kim YT (2013) Video-assisted thoracoscopic lobectomy in children: safety, efficacy, and risk factors for conversion to thoracotomy. Ann Thorac Surg 95:1236–1242CrossRefPubMed

Laje P, Pearson EG, Simpao AF, Rehman MA, Sinclair T, Hedrick HL et al (2015) The first 100 infant thoracoscopic lobectomies: Observations through the learning curve and comparison to open lobectomy. J Pediatr Surg 50:1811–1816CrossRefPubMed

Rothenberg SS, Middlesworth W, Kadennhe-Chiweshe A, Aspelund G, Kuenzler K, Cowles R et al (2015) Two decades of experience with thoracoscopic lobectomy in infants and children: standardizing techniques for advanced thoracoscopic surgery. J Laparoendosc Adv Surg Tech A 25:423–428CrossRefPubMed

10.

Kunisaki SM, Powelson IA, Haydar B, Bowshier BC, Jarboe MD, Mychaliska GB et al (2014) Thoracoscopic vs open lobectomy in infants and young children with congenital lung malformations. J Am Coll Surg 218:261–270CrossRefPubMed

11.

Nasr A, Bass J (2012) Thoracoscopic vs open resection of congenital lung lesions: a meta-analysis. J Pediatr Surg 47:857–861CrossRefPubMed

12.

Lau CT, Leung L, Chan IH, Chung PH, Lan LC, Chan KL et al (2013) Thoracoscopic resection of congenital cystic lung lesions is associated with better post-operative outcomes. Pediatr Surg Int 29:341–345CrossRefPubMed

13.

Rahman N, Lakhoo K (2009) Comparison between open and thoracoscopic resection of congenital lung lesions. J Pediatr Surg 44:333–336CrossRefPubMed

14.

Laberge JM, Flageole H, Pugash D, Khalife S, Blair G, Filiatrault D et al (2001) Outcome of the prenatally diagnosed congenital cystic adenomatoid lung malformation: a Canadian experience. Fetal Diagn Ther 16:178–186CrossRefPubMed

15.

Duncombe GJ, Dickinson JE, Kikiros CS (2002) Prenatal diagnosis and management of congenital cystic adenomatoid malformation of the lung. Am J Obstet Gynecol 187:950–954CrossRefPubMed

16.

Gornall AS, Budd JL, Draper ES, Konje JC, Kurinczuk JJ (2003) Congenital cystic adenomatoid malformation: accuracy of prenatal diagnosis, prevalence and outcome in a general population. Prenat Diagn 23:997–1002CrossRefPubMed

17.

Polites SF, Habermann EB, Zarroug AE, Thomsen KM, Potter DD (2016) Thoracoscopic Vs open resection of congenital cystic lung disease- utilization and outcomes in 1120 children in the United States. J Pediatr Surg 51:1101–1105CrossRefPubMed

18.

Seong YW, Yoo BS, Kim JT, Park IK, Kang CH, Kim YT (2012) Video-assisted thoracoscopic lobectomy in children: safety and efficacy compared with the conventional thoracotomy approach. Innovations (Phila) 7:394–398

19.

Kulaylat AN, Engbrecht BW, Hollenbeak CS, Safford SD, Cilley RE, Dillon PW (2015) Comparing 30-day outcomes between thoracoscopic and open approaches for resection of pediatric congenital lung malformations: Evidence from NSQIP. J Pediatr Surg 50:1716–1721CrossRefPubMed

20.

Rothenberg SS, Shipman K, Kay S, Kadenhe-Chiweshe A, Thirumoorthi A, Garcia A et al (2014) Thoracoscopic segmentectomy for congenital and acquired pulmonary disease: a case for lung-sparing surgery. J Laparoendosc Adv Surg Tech A 24:50–54CrossRefPubMed

21.

Takazawa S, Ishimaru T, Harada K, Tsukuda Y, Sugita N, Mitsuishi M et al (2015) Video-based skill assessment of endoscopic suturing in a pediatric chest model and a box trainer. J Laparoendosc Adv Surg Tech A 25:445–453CrossRefPubMed

22.

MacGillivray TE, Harrison MR, Goldstein RB, Adzick NS (1993) Disappearing fetal lung lesions. J Pediatr Surg 28:1321–1324CrossRefPubMed

23.

Adzick NS, Harrison MR, Crombleholme TM, Flake AW, Howell LJ (1998) Fetal lung lesions: management and outcome. Am J Obstet Gynecol 179:884–889CrossRefPubMed

24.

Kunisaki SM, Barnewolt CE, Estroff JA, Ward VL, Nemes LP, Fauza DO et al (2007) Large fetal congenital cystic adenomatoid malformations: growth trends and patient survival. J Pediatr Surg 42:404–410CrossRefPubMed

25.

Calvert JK, Lakhoo K (2007) Antenatally suspected congenital cystic adenomatoid malformation of the lung: postnatal investigation and timing of surgery. J Pediatr Surg 42:411–414CrossRefPubMed

26.

Naito Y, Beres A, Lapidus-Krol E, Ratjen F, Langer JC (2012) Does earlier lobectomy result in better long-term pulmonary function in children with congenital lung anomalies? A prospective study. J Pediatr Surg 47:852–856CrossRefPubMed

27.

Nakajima C, Kijimoto C, Yokoyama Y, Miyakawa T, Tsuchiya Y, Kuroda T et al (1998) Longitudinal follow-up of pulmonary function after lobectomy in childhood - factors affecting lung growth. Pediatr Surg Int 13:341–345CrossRefPubMed

28.

Keijzer R, Chiu PPL, Ratjen F, Langer JC (2009) Pulmonary function after early vs late lobectomy during childhood: a preliminary study. J Pediatr Surg 44:893–895CrossRefPubMed

29.

Dunnil M (1962) Postnatal growth of the lung. Thorax 17:329–333CrossRef

30.

Vu LT, Farmer DL, Nobuhara KK, Miniati D, Lee H (2008) Thoracoscopic versus open resection for congenital cystic adenomatoid malformations of the lung. J Pediatr Surg 43:35–39CrossRefPubMed

31.

Thurlbeck WM (1982) Postnatal human lung growth. Thorax 37:564–571CrossRefPubMedPubMedCentral

32.

Komori K, Kamagata S, Hirobe S, Toma M, Okumura K, Muto M et al (2009) Radionuclide imaging study of long-term pulmonary function after lobectomy in children with congenital cystic lung disease. J Pediatr Surg 44:2096–2100CrossRefPubMed

Title: Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve
Authors: Samina Park
Eung Re Kim
Yoohwa Hwang
Hyun Joo Lee
In Kyu Park
Young Tae Kim
Chang Hyun Kang
Publication date: 01-10-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 10/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5425-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Serial improvement of quality metrics in pediatric thoracoscopic lobectomy for congenital lung malformation: an analysis of learning curve

Abstract

Background

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Please log in to get access to this content

Other articles of this Issue 10/2017

Learning colorectal endoscopic submucosal dissection: a prospective learning curve study using a novel ex vivo simulator

Volume and outcomes relationship in laparoscopic diaphragmatic hernia repair

Laparoscopic image-based navigation for microwave ablation of liver tumors—A multi-center study

A novel laparoscopic technique for anorectal malformation with low recto-bulbar fistulae

Long-term oncological outcomes in robotic gastrectomy versus laparoscopic gastrectomy for gastric cancer: a meta-analysis

Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score-matched analysis