Department of General Surgery and Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumour, The First School of Clinical Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China.
Updates Surg. 2023 Jun;75(4):987-994. doi: 10.1007/s13304-023-01492-w. Epub 2023 Mar 28.
Gasless transaxillary posterior endoscopic thyroidectomy (GTPET) is a new approach for thyroid cancer. It allows en bloc resection of the thyroid and central lymph nodes. Few studies have reported on the learning curve for GTPET.We examined the learning curve of GTPET for thyroid cancer by cumulative sum (CUSUM) analysis by retrospectively analyzing patients who underwent hemithyroidectomy with ipsilateral central neck dissection between December 2020 and September 2021 at a tertiary medical center, including the first patient. Moving average analysis and sequential time-block analysis were used for validation. Data on the clinical factors between the two periods were compared. In the overall cohort, the average time for GTPET for thyroid cancer was 113.25 min to harvest an average of 6.4 central lymph nodes. The CUSUM curve of the operative time indicated an inflection point after 38 patients. Moving average analysis and sequential time-block analysis validated the number of procedures needed for GTPET proficiency. (124.05 min vs. 107.63 min for the unproficient period vs. proficient period, respectively; P < 0.001) The number of retrieved lymph nodes was not associated with a certain level of proficiency per the learning curve. The main complication during the surgeon's unproficient period was transient hoarseness (3/38), which was similar to that in their proficient period (2/73, p = 0.336). Proficiency in GTPET is associated with performing more than 38 procedures. Standard course training and instruction on careful management are required prior to introducing the procedure.
无气经腋窝内镜甲状腺切除术（GTPET）是一种治疗甲状腺癌的新方法。它可以整块切除甲状腺和中央淋巴结。目前仅有少数研究报道了 GTPET 的学习曲线。我们通过回顾性分析 2020 年 12 月至 2021 年 9 月在一家三级医疗中心接受单侧甲状腺全切术和同侧中央颈部淋巴结清扫术的患者（包括首例患者），应用累积和（CUSUM）分析来检验 GTPET 治疗甲状腺癌的学习曲线。同时采用移动平均分析和序贯时间块分析进行验证。比较了两个时期的临床因素数据。在总体队列中，GTPET 治疗甲状腺癌的平均时间为 113.25 分钟，平均收获 6.4 个中央淋巴结。手术时间的 CUSUM 曲线在 38 例患者后出现拐点。移动平均分析和序贯时间块分析验证了 GTPET 熟练所需的手术次数。（分别为 124.05 分钟和 107.63 分钟；熟练组与非熟练组比较，P<0.001）根据学习曲线，GTPET 学习曲线中所涉及的淋巴结数量与熟练程度之间无相关性。在手术医生非熟练阶段的主要并发症是短暂性声音嘶哑（3/38），与熟练阶段相似（2/73，p=0.336）。GTPET 熟练程度与完成 38 次以上手术有关。在引入该手术之前，需要进行标准课程培训和关于精细管理的指导。
