Steering group , Alessandro Brunelli, Herbert Decaluwe, Michel Gonzalez, Dominique Gossot, Rene Petersen, Expert panel , Florian Augustin, Jalal Assuad, Jean Ma

This study aimed to analyze surgeons’ learning curve for thymoma resection with video-assisted thoracoscopic surgery (VATS). Two hundred and eleven myasthenia gravis patients had VATS thymic resections, including 25 patients with a thymoma. Three groups of surgeries, according to the order of operations, were analyzed: Group A comprised the first 70 thymectomies, Group B comprised the second 70 thymectomies, and Group C comprised the final 71 thymectomies. We compared the groups on a set of preoperative (age, gender, body mass index, and Osserman stage), operative (number in each group, size, and Masaoka stage), and postoperative (complications and length of stay) variables. A significant difference was observed in the number of thymoma operations (Group A: four patients, Group B: seven patients, and Group C: 14 patients; P: 0.031) and the duration of operation (Group A: 66 min, Group B: 52 min, and Group C: 48 min; P: 0.024). A strong correlation was found between the duration of operation and order of patients (Pearson r: –0.554, P: 0.000). We recommend the start of a program for the resection of thymoma with VATS after surgical staff have performed 70 VATS thymectomy operations.

Objective: Videothoracoscopic learning curve is known to vary among different surgeons, and may be influenced by patients and various situations. We aimed to analyze the learning curve of a surgeon in videothoracoscopic thymic surgery for myasthenia gravis. Methods: This is a descriptive single-center study using collected clinical data from 90 patients undergoing videothoracoscopic thymic surgery between June 2002 and September 2006. Cumulative summation (CUSUM) model was used to evaluate the learning curve for videothoracoscopic thymectomy operations. Unsuccessful situations were accepted as longer operation time, surgeon-related open conversions, readmissions and postoperative complications. Factors affecting longer operation time (patients with operation time longer than the average) and longer postoperative stay (patients with postoperative hospital stay longer than average) were analyzed. Results: Body mass index (BMI) was the only predictor of longer operation time (23.04 ± 2.93 vs 25.61 ± 2.70 (p = 0.001) independent samples test). The amount of prescribed pyridostigmine was the only factor for longer hospital stay (213.3 ± 101.5 mg vs 270. 0 ± 122.6 mg (p = 0.044) Mann–Whitney U-test). CUSUM analysis demonstrated a learning curve with success rates of 80%, 90% and 98%, respectively in the first 30 patients, the next 31–60 patients and after 60 patients. Median operative time declined with surgeons’ experience (p < 0.001). Conclusions: A chest surgeon can have a high success rate in videothoracoscopic thymectomy (98%) after 60 operations.

Mediastinal lymph node dissection is an essential component of lung cancer surgery. Literature lacks established information regarding the number and size of the healthy lymph nodes. In this postmortem autopsy study, we aim to define the number, size and weight of the lymph nodes in each mediastinal lymph node station. To implement the data for the clinical practice, we analyzed the possible number of nodes to be dissected in a systematic mediastinal lymph node dissection from the right and left sides during lung cancer surgery.

Tracheotomy is a surgical procedure commonly employed to establish stable and long-term airway access. Iatrogenic airway injury post procedure may have serious consequences with limited treatment options. Tracheostoma or long standing tracheostomies require special closing techniques. Tracheotomies, tracheostomies, complications of these and treatment options, long standing tracheostomy closure techniques, and standard tracheal segmental resections are discussed.