Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

Abstract

With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.

Cumulative Sum Analysis of the Operator Learning Curve for Robot-Assisted Mayo Clinic Level I–IV Inferior Vena Cava Thrombectomy Associated with Renal Carcinoma: A Study of 120 Cases at a Single Center

“…The standardization of the surgical procedure and the modification of the surgical technique with increasing numbers of cases may further reduce the mean operative time and estimated blood loss, and the inflection points may change accordingly. Compared with some recent studies involving cumulative sum analysis for other types of robotic surgery [21][22][23][24][25], the present study identified a similar boundary case number ranging from 25 to 50, or between 20% and 50%. However, as far as we know, there has been no previously reported study on the learning curve of robot-assisted IVC thrombectomy for reference.…”

Unilateral axilla-bilateral areola approach for thyroidectomy by da Vinci robot vs. open surgery in thyroid cancer: a retrospective observational study

“…Studies have shown that the learning curve for robotic thyroid surgery requires more than 50 cases (7,(28)(29)(30)(31). However, the surgeon should be more experienced and proficient in addressing complicated situations in thyroid surgery.…”

Impact of bedside assistant on outcomes of robotic thyroid surgery

“…Our previous study indicated that 50 to 75 cases of BABA robotic surgery were required to overcome the learning curve of the console surgeon. [ 8 ] Thus, the first 100 cases of the console surgeon were not included in the present study. As a result, the mean operative time of the DRA group (183.2 ± 33.6 minutes) was significantly lower than that of the NRA group (203.1 ± 37.9 minutes; P < .001).…”

“…[ 5 – 7 ] With the increased application of the surgical robots for thyroidectomy in recent years, proficiency and experience of the surgeon are major concerns. [ 8 ]…”

“…Previous studies investigating learning curves for robotic thyroidectomy have indicated that operative times decrease gradually and reach a steady state after 35 to 50 cases. [ 8 , 11 , 12 ] These studies analyzed the relationship between the experience of the surgeon and perioperative variables, including operative times, complication rates, blood loss, and the number of dissected lymph nodes. However, the role of the surgical assistant was not taken into consideration.…”