Fassari Alessia, Gurrado Angela, Iossa Angelo, Micalizzi Alessandra, Polistena Andrea, Sibio Simone, Crocetti Daniele, Bononi Marco, Testini Mario, Avenia Nicola, Cavallaro Giuseppe
General Surgery Unit, Luxembourg Hospital Center, Luxembourg, Luxembourg.
Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy.
Gland Surg. 2023 Jul 31;12(7):989-1006. doi: 10.21037/gs-22-730. Epub 2023 Jul 4.
Thyroidectomy is one of the most common surgical procedures carried out worldwide and it has evolved in recent years with alternative approaches. With the advent of minimally invasive techniques, the learning curve (LC) concept has become a fundamental "dogma".
A literature search, according to the PRISMA guidelines, was performed via PubMed (MEDLINE), Scopus, Cochrane Library, EMBASE, and Web of Science. Only studies assessing the learning process to thyroidectomy (including hemi- and total thyroidectomy), reporting a minimum of 30 procedures and describing clearly the minimum number of performances required to achieve proficiency and the main evaluation items used to establish it, were included. Conventional, endoscopic and robotic approaches were separately analyzed. Only English-language studies were considered.
Forty-five relevant studies were selected for the analysis [respectively 16 concerning robotic thyroidectomy (RT), 22 endoscopic thyroidectomy (ET), 6 mini-invasive video assisted thyroidectomy (MIVAT), 1 conventional thyroidectomy (CT)]. The number of procedures required for a single surgeon to achieve competence and the parameters used to define surgical proficiency were fully investigated for each individual technique.
Our research shows how the current literature lacks an objective definition of the LC concept. The heterogeneity of analysis methodologies and parameters evaluated, the various surgical techniques and training background of single surgeons, make it impossible to draw univocal results. Future studies should consider confounding factors and establish criteria that should be consensually recognized in the assessment of surgical performances and skills.
甲状腺切除术是全球最常见的外科手术之一，近年来随着替代方法的出现而不断发展。随着微创技术的出现，学习曲线（LC）概念已成为一个基本的“教条”。
根据PRISMA指南，通过PubMed（MEDLINE）、Scopus、Cochrane图书馆、EMBASE和科学网进行文献检索。仅纳入评估甲状腺切除术（包括半甲状腺切除术和全甲状腺切除术）学习过程的研究，报告至少30例手术，并清楚描述达到熟练程度所需的最少手术次数以及用于确定熟练程度的主要评估项目。对传统、内镜和机器人手术方法分别进行分析。仅考虑英文研究。
选择45项相关研究进行分析[分别为16项关于机器人甲状腺切除术（RT）、22项内镜甲状腺切除术（ET）、6项微创视频辅助甲状腺切除术（MIVAT）、1项传统甲状腺切除术（CT）]。对每种技术，全面研究了单个外科医生达到胜任能力所需的手术次数以及用于定义手术熟练程度的参数。
我们的研究表明，当前文献缺乏对学习曲线概念的客观定义。分析方法和评估参数的异质性、各种手术技术以及单个外科医生的培训背景，使得无法得出明确的结果。未来的研究应考虑混杂因素，并建立在评估手术表现和技能时应得到共识认可的标准。
