Division of General Surgery, Department of Surgery, Zuoying District, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Kaohsiung, 81362, Taiwan.
School of Medicine, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, 11221, Taiwan.
World J Surg. 2021 May;45(5):1446-1456. doi: 10.1007/s00268-021-05953-4. Epub 2021 Jan 29.
Endoscopic thyroidectomy has comparable surgical outcomes and superior cosmetic satisfaction to open thyroidectomy. However, steep learning curve is a concern. This study evaluated the learning curve of endoscopic thyroidectomy using various parameters and statistical methods.
A total of 90 consecutive patients who underwent endoscopic thyroidectomy using bilateral axillo-breast approach (BABA) between March 2016 and April 2020 were enrolled. Operative time, postoperative drainage amount, and blood loss were assessed by cumulative sum (CUSUM) analysis and moving average to evaluate the learning curve.
Using the CUSUM analysis, the peak point of both operative time and drainage amount occurred at the 30th case. No clear single peak was identified in the CUSUM plot for blood loss. The moving average also showed significant reduction in operative time and drainage amount after, approximately, the first 30 cases. The blood loss decreased after the 25th case. We therefore divided the patients into 2 phases: phase 1 (1-30 cases) and phase 2 (31-90 cases). The operative time, drainage amount, and blood loss decreased significantly in the phase 2 compared with phase 1. Lower pain score in first postoperative day and shorter hospital stay were also observed in the phase 2. Although the reduction in transient hypoparathyroidism did not reach statistical significance, no permanent hypoparathyroidism was noted in the phase 2.
The learning curve for endoscopic thyroidectomy is approximately 30 cases. Aside from the operative time, drainage amount may also serve as a surrogate for the learning curve evaluation.
内镜甲状腺切除术在手术结果和美容满意度方面与开放甲状腺切除术相当，但存在陡峭的学习曲线。本研究使用多种参数和统计方法评估内镜甲状腺切除术的学习曲线。
共纳入 2016 年 3 月至 2020 年 4 月期间采用双侧乳晕入路内镜甲状腺切除术（BABA）治疗的 90 例连续患者。使用累积和（CUSUM）分析和移动平均评估手术时间、术后引流量和出血量等参数来评估学习曲线。
CUSUM 分析显示手术时间和引流量的峰值出现在第 30 例，而出血量的 CUSUM 图中没有明显的单一峰值。移动平均也显示手术时间和引流量在大约前 30 例后显著减少。出血量在第 25 例后减少。因此，我们将患者分为 2 期：第 1 期（1-30 例）和第 2 期（31-90 例）。第 2 期的手术时间、引流量和出血量明显低于第 1 期。第 2 期术后第 1 天的疼痛评分较低，住院时间较短。尽管暂时性甲状旁腺功能减退的减少没有达到统计学意义，但第 2 期没有永久性甲状旁腺功能减退。
内镜甲状腺切除术的学习曲线约为 30 例。除手术时间外，引流量也可作为学习曲线评估的替代指标。
