Analysis Of Learning Curve For Video-Assisted Thoracoscopic Surgery For Total Thymectomy Via The Subxiphoid Approach

Objective:This study aims at analyze the clinical data of 39 patients with thoracoscopic subxiphoid approach total thymectomy by CUSUM accumulation and learning curve analysis,and discuss how to use learning curve to guide and improve the effectiveness and safety of thoracoscopy subxiphoid approach total thymectomy.Methods:This study retrospectively analyzed and statistically analyzed the clinical data of 39 consecutive patients with thoracoscopic subxiphoid approach total thymectomy performed by the same treatment group in the General Hospital of Northern Theater Command from January 2020 to December 2022.The operation time and intraoperative blood loss were calculated by CUSUM analysis.Fit the CUSUM curve and observe the position where the curve crosses the vertex.Divided all 39 patients into learning the exploration group(Group A)and proficiency stable group(Group B)according to the highest point of CUSUM curve of operation time,analyzed and compared the basic data(age,gender,BMI,maximum diameter of tumor suggested by preoperative CT,maximum diameter of tumor suggested by postoperative pathology,postoperative pathological results)and the operation evaluation data(operation time,intraoperative blood loss,intraoperative complications,total postoperative drainage,postoperative extubation time,postoperative hospitalization time,postoperative complications)of the two groups to explore the learning effect of thoracoscopy through subxiphoid approach,in order to achieve better results in the following practice.Results:The total operation time of thoracoscopic subxiphoid approach total thymectomy was 135.44±38.89 minutes.SPSS curve fitting can get the cumulative sum and learning curve of operation time,that is,operation time CUSUM=0.047X~3-3.356X~2+60.547X+14.696(X is the number of operations).The evaluation index of the curve R~2=0.891,P<0.05.The curve fitting results show that the slope turns from positive to negative when the number of operations reaches 12.Intraoperative blood loss CUSUM=0.008X~3-0.888X~2+22.052X+12.212,R~2=0.961,P<0.05.The curve shows that the curve crosses the vertex when the number of operations reaches 16,and the slope turns from positive to negative.With the crossing point of the CUSUM curve of operation time as the boundary,all the cases were divided into learning improvement group(Group A)and proficiency stable group(Group B).The results showed that the operation time,intraoperative blood loss and total postoperative drainage in the learning improvement stage were significantly higher than those in the proficient and stable stage(P<0.05),while there was no significant difference between Group A and Group B in postoperative extubation time,postoperative hospitalization time,intraoperative complications and postoperative complications(P>0.05).Conclusion:The CUSUM cumulative sum analysis method can be used to calculate the crossing point values of operation time and intraoperative blood loss.The number of case crossing the learning curve of operation time was 12.The number of case crossing the intraoperative blood loss control curve was 16.The CUSUM cumulative sum analysis can provide effective guidance for clinical application,thus providing effective preparation for different stages of surgery.