Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Lithuanian University of Health Sciences, Kaunas, Lithuania.
Updates Surg. 2022 Jun;74(3):917-925. doi: 10.1007/s13304-022-01286-6. Epub 2022 Apr 30.
Conventional open thyroidectomy is defined as a gold standard in thyroid gland disease treatment. However, progressive surgery methods such as endoscopic technique provide better structure visualisation and improved cosmetic effect. Our study aim is to compare conventional open (COH) and endoscopic transaxillary hemithyroidectomy (TAH) and define the learning curve for TAH procedure. We retrospectively analysed 107 COH and 65 TAH cases. Patients' demographic data and surgery results were compared. Also, surgeon learning curve analysis using cumulative sum (CUSUM) was performed for the duration of the surgery. TAH was applied to younger female patients with lower thyroid gland volume. COH group patients were hospitalised for longer in comparison with TAH (p < 0.05). Mean TAH surgery time was longer (78.1 min, SD = 22.6) compared with COH (66.7 min, 15.3) (p < 0.05). Overall complication rate was comparable between groups. There was a tendency towards a lower unintentional parathyroidectomy rate in TAH group. TAH group results showed significantly longer surgery time for patients whose body mass index (BMI) was over 30 (kg/m), compared to whose BMI was below 30 (kg/m) (p = 0.004). Shortest endoscopic surgery time (64.9 ± 12.45 min) was achieved between 41 and 50 cases. CUSUM analysis showed that surgery time decreased after the 30th TAH case. TAH approach compared to COH results in longer surgery time, shorter hospital stay and comparable rate of postoperative complications. However matched pair studies are necessary to clarify the results. After thirty cases, the surgeon became proficient in transaxillary endoscopic thyroid surgery.
传统的开放甲状腺切除术被定义为甲状腺疾病治疗的金标准。然而，内镜技术等不断发展的手术方法可以提供更好的结构可视化和改善美容效果。我们的研究目的是比较传统开放（COH）和内镜经腋窝半甲状腺切除术（TAH），并定义 TAH 手术的学习曲线。我们回顾性分析了 107 例 COH 和 65 例 TAH 病例。比较了患者的人口统计学数据和手术结果。还使用累积和（CUSUM）对手术时间进行了外科医生学习曲线分析。TAH 适用于甲状腺体积较小的年轻女性患者。与 TAH 相比，COH 组患者的住院时间更长（p<0.05）。TAH 的平均手术时间（78.1 分钟，SD=22.6）长于 COH（66.7 分钟，15.3）（p<0.05）。两组总体并发症发生率相当。TAH 组无意甲状旁腺切除率有降低的趋势。对于 BMI 超过 30（kg/m）的患者，TAH 组的手术时间明显长于 BMI 低于 30（kg/m）的患者（p=0.004）。最短的内镜手术时间（64.9±12.45 分钟）是在 41 到 50 例之间获得的。CUSUM 分析显示，在第 30 例 TAH 手术后，手术时间减少。与 COH 相比，TAH 方法的手术时间更长，住院时间更短，术后并发症发生率相当。然而，有必要进行配对研究以澄清结果。在 30 例之后，外科医生在经腋窝内镜甲状腺手术方面变得熟练。
