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Eur J Pediatr Surg
DOI: 10.1055/a-2767-7356
Original Article

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

Authors

  • Minhua Lin 

    1   Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China

  • Jiachi Liao

    1   Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China

  • Le Li

    1   Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Abstract

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 1-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 surgical experiences and insights were summarized. 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 three patients (1.9%), and residual lesions were identified in four 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 with 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 1-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 due to a lack of long-term follow-up data, the safety and efficacy of this technique still require further validation through multi-center studies.

Keywords

congenital malformation of lung airway - anatomical pulmonary lesion resection - learning curve - children

Contributors' Statement

M.L., J.L., and L.L.: study conception and design; M.L. and J.L.: data acquisition; M.L. and J.L.: analysis and data interpretation; M.L. and J.L.: drafting of the manuscript; M.L., J.L., and L.L.: critical revision.




Publication History

Received: 22 May 2025

Accepted: 08 December 2025

Accepted Manuscript online:
19 December 2025

Article published online:
31 December 2025

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