Surgical outcomes and learning curve of complex versus simple segmentectomy for uniportal video-assisted thoracoscopic surgery: an initial experience of 100 cases of a single experienced surgeon

Background: Complex segmentectomy for uniportal video-assisted thoracoscopic surgery (VATS) remains controversial due to procedural complexity and the risk of increased complications, unlike multiportal VATS. Demonstrating the perioperative results and proficiency of individual surgeon is believed to influence future dissemination for uniportal VATS. In this study, we aimed to compare the perioperative outcomes and learning curves of complex versus simple segmentectomy for uniportal VATS.

Methods: This retrospective cohort study included all patients who had an elective uniportal VATS segmentectomy between July 2018 and June 2023. We documented our initial experience with 100 consecutive segmentectomy cases. A single board-certified experienced surgeon performed all procedures. The perioperative outcomes of the complex (n=45) and simple (n=55) segmentectomy groups were compared using propensity score matching and the cumulative sum technique.

Results: Using propensity score matching, 29 patients were chosen from each group. There was no statistically significant difference between the two groups in perioperative outcomes. The initial learning curve for simple segmentectomy was completed after 20 cases, while that for complex segmentectomy was completed after 11 cases.

Conclusions: Uniportal VATS complex segmentectomy was safe and comparable to simple segmentectomy in terms of perioperative outcomes and learning curves in an experienced surgeon. Uniportal VATS complex segmentectomy should be considered a viable surgical option.