The learning curve for endoscopic thyroidectomy: a single surgeon’s experience

Liu, Sheng; Qiu, Ming; Jiang, Dao-Zhen; Xiao, Zheng; Zhang, Wei; Shen, Hongliang; Shan, Cheng-Xiang

doi:10.1007/s00464-009-0332-7

Cited by 68 publications

(75 citation statements)

References 13 publications

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“…It should be noted, however, that such procedures are technically demanding and require a surgical team skilled in both endocrine and endoscopic surgery. This is particularly true in the case of some endoscopic techniques that require a significant learning period, which can be time consuming, especially early in a surgical career [24,25].…”

Section: Discussionmentioning

confidence: 99%

Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy

et al. 2010

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Background Robotic thyroidectomy using a gasless transaxillary approach, first described in 2008, has become popular. This study compared outcomes, including postoperative distress and patient satisfaction, for patients undergoing robotic thyroidectomy with those for patients treated by conventional open thyroidectomy. Methods Of 84 prospectively enrolled patients, 41 underwent robotic thyroidectomy (the robot group), and 43 received conventional open thyroidectomy (the open group). All the patients were followed up for at least 3 months after surgery. Videolaryngostroboscopic examinations were performed preoperatively and after 1 week and after 3 months postoperatively. Postoperative pain and discomfort were evaluated using a symptom scale. Subjective voice and swallowing changes were assessed by questionnaires; and satisfaction with cosmetic outcome was measured by verbal response at 3 months. Results The two groups were similar in age, gender, type of operation, and final pathologic diagnosis. Although the mean operating time was significantly longer with the robotic technique than with open surgery, there were no betweengroup differences in postoperative pain or duration of hospital stay. No patient in either group experienced any major postoperative complication. Postoperative discomfort in the neck and swallowing disturbances were significantly more frequent in the open group than in the robot group, both at 1 week and at 3 months after surgery. However, there was no significant between-group difference in subjective voice parameters. At 3 months, the mean cosmetic satisfaction score was significantly higher in the robotic than in the open group. Conclusion Although postoperative pain levels and complications were comparable in the two groups, conventional open thyroidectomy requires a shorter operative time. The robotic technique, however, offers several distinct advantages including very good to excellent cosmetic results, reduced postoperative neck discomfort, and fewer adverse swallowing symptoms.Keywords Comparative study Á Cosmetic result Á Postoperative neck discomfort Á Robotic thyroidectomy Á Swallowing symptom Most patients with thyroid tumors are effectively treated surgically by practitioners experienced in the techniques of thyroidectomy. Many patients, especially women, undergoing thyroid surgery are concerned about the postoperative cosmetic appearance of the neck. Neck surgery also may result in postoperative discomfort, with pain, hyperesthesia, and paresthesia [1][2][3].

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Section: Discussionmentioning

confidence: 99%

Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy

et al. 2010

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“…To evaluate further the association between NS experience and operative time, one-way analysis of variance (ANOVA) was used to compare operative time. 9 We also analyzed the categorical variables including complications between the ten subcategories of NS groups compared with neighboring group. Pearson's chi-square test was used to analyze differences in the rates among groups.…”

Section: Statisticsmentioning

confidence: 99%

“…8 The learning curve for conventional endoscopic unilateral lobectomy is estimated to be 60 cases for skilled endocrine surgeons. 9 Compared with endoscopic thyroidectomy, use of the robot in an endoscopic approach provides a broader view of the thyroid bed, albeit from a lateral as opposed to the conventional anterior perspective. In addition, multi-articulated instruments provide easy access to deep and narrow corner spaces and allow complete central node dissection.…”

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confidence: 99%

The Learning Curve for Robotic Thyroidectomy: A Multicenter Study

Yun²,

et al. 2010

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Purpose. The learning curve for robotic thyroidectomy with central compartment node dissection (CCND) has not been established. We examined the effect of experience of robotic thyroidectomy on a range of perioperative parameters in order to determine the learning curve. The learner surgeon outcomes were compared with those of an experienced surgeon. Methods. We conducted a prospective, controlled, multicenter study involving four endocrine surgeons at three academic centers. Patients underwent robotic total or subtotal thyroidectomy with CCND between September 2008 and October 2009. One surgeon was experienced in the technique (experienced surgeon, ES), while the other three surgeons had endoscopic thyroid surgery experience but no experience performing the robotic procedure (nonrobotic thyroid surgery experienced surgeon, NS). Outcome measures were demographic data, operative time, blood loss, hospital stay, pathologic results, and postoperative complications. Results. A total of 644 total or subtotal robotic thyroidectomies with CCND were performed: 377 (58.7%) by NSs and 267 (41.5%) by the ES. Mean operative time was longer and the complication rate was higher for the NS patient group compared with the ES patient group (P \ 0.001 for each). The operative times and complications rates for the NS group were similar to those of the ES group once the NSs had performed 50 cases for total thyroidectomies or 40 cases for subtotal thyroidectomies. Conclusion. The learning curve duration for robotic thyroidectomy with CCND using gasless transaxillary approach for experienced endoscopic thyroidectomy surgeons was 50 cases for total thyroidectomy and 40 cases for subtotal thyroidectomy.Endoscopic thyroid and parathyroid surgery have emerged as viable options for surgical management of thyroid tumors since the first descriptions of endoscopic parathyroidectomy by Gagner in 1996 and video-assisted thyroid lobectomy by Huscher in 1997.

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“…Eligibility criteria were the same as for conventional ETBA: benign thyroid nodules (diameter < 5 cm) and papillary microcarcinoma diagnosed by preoperative ultrasound and fine needle aspiration cytology. Exclusion criteria were: a history of neck surgery or radiotherapy; thyroiditis diagnosed by preoperative biochemistry or ultrasound; liver dysfunction; and autoimmune disease (10,11). Twenty consecutive patients who underwent standard ETBA (sETBA) from June to September 2012 (17 women; mean age: 38.85 ± 9.95 years) served as the control group.…”

Section: Patient Demographicsmentioning

confidence: 99%

“…sETBA has been described previously (10,11). Briefly, three incisions were made: a 12-15-mm curved longitudinal parasternal incision for the camera port and two 5-mm working port incisions in the circumareolar region.…”

Section: Thyroidectomymentioning

confidence: 99%

Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes

Zhang

Dang

Shan

et al. 2014

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The learning curve for endoscopic thyroidectomy: a single surgeon’s experience

Abstract: The first 60 cases constitute the early stage of the learning curve for endoscopic thyroidectomy. The proficiency and stability of the operation reach the advanced level after 150 cases.

Cited by 68 publications

References 13 publications

Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy

Differences in postoperative outcomes, function, and cosmesis: open versus robotic thyroidectomy

The Learning Curve for Robotic Thyroidectomy: A Multicenter Study

Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes

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