Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, 162 avenue Lacassagne, F-69424, Lyon, France.
World J Surg. 2011 Apr;35(4):773-8. doi: 10.1007/s00268-011-0963-4.
When assessing the value of intraoperative nerve monitoring (IONM) during routine thyroidectomy, it is necessary to consider its influence on the surgeon's dissection technique. We investigated the effect of IONM on individual surgeon performance by determining the learning curve associated with this tool.
A one-year prospective study was conducted between May 2008 and April 2009 within a team of three experienced endocrine surgeons. The measure of surgical performance was based on the detection of immediate postoperative recurrent laryngeal nerve palsy by laryngoscopy. Individual learning curves associated with IONM acquisition were drawn with the cumulative sum (CUSUM) chart. Each surgeon was questioned about possible changes he had experienced in his own surgical technique after the introduction of IONM.
A total of 475 consecutive patients who underwent thyroid surgery with IONM were included. The pattern of learning curves varied among surgeons and ranged from 35 to 304 procedures required for complete IONM acquisition. The surgeon with the longest learning curve also described a drastic modification of his technique related to nerve dissection.
Intraoperative nerve monitoring can induce changes in surgical practice. The different learning curve patterns among surgeons may reflect the variable degree to which surgeons will modify their own dissection technique. Such an effect on learning must be considered when assessing the impact of using IONM on patient safety.
在评估常规甲状腺切除术期间术中神经监测（IONM）的价值时，有必要考虑其对外科医生手术技术的影响。我们通过确定与该工具相关的学习曲线，研究了 IONM 对个体外科医生表现的影响。
在 2008 年 5 月至 2009 年 4 月期间，由三位经验丰富的内分泌外科医生组成的团队进行了为期一年的前瞻性研究。手术表现的衡量标准是基于喉镜检查发现术后即刻喉返神经麻痹。使用累积和（CUSUM）图绘制与 IONM 获取相关的个体学习曲线。每位外科医生都被问到在引入 IONM 后，他的手术技术是否发生了变化。
共纳入 475 例接受 IONM 甲状腺手术的连续患者。学习曲线的模式在外科医生之间有所不同，从 35 例到完全获取 IONM 所需的 304 例不等。学习曲线最长的外科医生还描述了与神经解剖相关的技术的急剧改变。
术中神经监测可能会引起手术实践的改变。外科医生之间不同的学习曲线模式可能反映了外科医生改变自身解剖技术的程度不同。在评估使用 IONM 对患者安全性的影响时，必须考虑这种学习效果。
