Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery

Park, Jae Hyun; Lee, Jandee; Hakim, Nor Azham; Kim, Ha Yan; Kang, Sang Wook; Jeong, Jong Ju; Nam, Kee Hyun; Bae, Keum Seok; Kang, Seong Joon; Chung, Woong Youn

doi:10.1002/hed.23824

Cited by 38 publications

(45 citation statements)

References 29 publications

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“…Our 20 RFT cases were completed over a 4.5‐year period, while the same number of cases were completed in 1 year in the TOETVA cohort. That being said, our institutional learning curves are consistent with previous literature citing the learning curve for robotic thyroidectomy techniques to be on the order of 35 to 50 cases, while an estimate of 7 to 10 cases has been previously cited as the learning curve for TOETVA . Likewise, the difference in baseline experience between surgeons in the respective cohorts may have also contributed to the difference in rate of skill acquisition, as the surgeon in the TOETVA cohort had no prior laparoscopic experience, while the surgeon in the RFT cohort was an experienced transoral robotic surgeon.…”

Section: Discussionsupporting

confidence: 86%

Anterior cervical incision‐sparing thyroidectomy: Comparing retroauricular and transoral approaches

Russell

Razavi

Khadem

et al. 2018

Laryngoscope Investig Oto

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ObjectivesThe robotic retroauricular approach and transoral endoscopic thyroidectomy vestibular approach (TOETVA) have been employed to avoid anterior neck scarring in thyroidectomy with good success. However, outcomes have yet to be compared between techniques. We compare our initial clinical experience with these approaches for thyroid lobectomy at our institution.MethodsA review of initial consecutive patients who underwent robotic facelift thyroidectomy (RFT) (August 2011–August 2016) at our institution was conducted. This was compared with the same number of initial consecutive patients who underwent TOETVA (September 2016–September 2017) at our institution. Demographics, operative time, pathology, complications, and learning curve were compared between cohorts. Learning curve was defined based on the slope of linear regression models of operative time versus case number.ResultsThere were 20 patients in each cohort. There was no statistically significant difference in demographic data between cohorts. One hundred percent of RFT cases versus 95% TOETVA cases (P = .999) were completed without conversion to standard open technique with median operative times of 201 (124–293) minutes versus 188 (89–343) minutes with RFT and TOETVA, respectively (P = .36). There was no incidence of permanent recurrent laryngeal nerve injury in either cohort. The slopes of the regression models were 0.29 versus −8.32 (P = .005) for RFT and TOETVA, respectively.ConclusionRFT and TOETVA are safe and feasible options for patients motivated to avoid an anterior neck scar. However, the quicker learning curve without the need for a costly robotic system may make TOETVA the preferred technique for institutions wishing to perform anterior cervical incision‐sparing thyroidectomy.Level of Evidence4

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Section: Discussionsupporting

confidence: 86%

Anterior cervical incision‐sparing thyroidectomy: Comparing retroauricular and transoral approaches

Russell

Razavi

Khadem

et al. 2018

Laryngoscope Investig Oto

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“…The longer operative time in these approaches is mainly owing to the longer time required for flap elevation and robotic/endoscopic instrument setting; however, this shortcoming is expected to be overcome by more extensive surgical experience using these techniques, and by improvements in surgical instrumentation. 12 However, surgeons should keep in mind that longer operation times and the associated postoperative morbidity may be inevitable even in the hands of an experienced surgeon. Moreover, the procedures in this study were performed by a high-volume surgeon (performing >200 cases of conventional thyroidectomy and over 150 cases of extracervical thyroidectomy per year).…”

Section: Discussionmentioning

confidence: 99%

Comparison of transaxillary approach, retroauricular approach, and conventional open hemithyroidectomy: A prospective study at single institution

Lee

Han

et al. 2016

Surgery

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“…18 A P value < .05 was considered statistically significant. Continuous data were compared using Student's t tests, whereas categorical data were compared using chi-square tests.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a clinical pathway for patients with thyroid cancer

et al. 2018

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Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery

Abstract: The surgical learning curve for robotic thyroidectomy performed by recently graduated fellowship-trained surgeons with little or no experience in endoscopic surgery showed excellent results compared with those in a large series of more experienced surgeons.

Cited by 38 publications

References 29 publications

Anterior cervical incision‐sparing thyroidectomy: Comparing retroauricular and transoral approaches

Anterior cervical incision‐sparing thyroidectomy: Comparing retroauricular and transoral approaches

Comparison of transaxillary approach, retroauricular approach, and conventional open hemithyroidectomy: A prospective study at single institution

Efficacy of a clinical pathway for patients with thyroid cancer

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