Department of General Surgery, The First Affiliated Hospital, Jinan University, Guangzhou, 510630, Guangdong, P.R. China.
Department of Minimally Invasive Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of TCM), Guangzhou, 510120, Guangdong, P.R. China.
BMC Surg. 2024 Nov 26;24(1):375. doi: 10.1186/s12893-024-02666-y.
Endoscopic lateral neck dissection (LND) can be a scarless procedure if a surgeon has performed a sufficient number of operations to become skilled at the techniques involved. Here, we examine the learning curve for a surgeon who performed 53 endoscopic LND procedures via chest approach.
Surgical outcomes for 53 patients with papillary thyroid carcinoma who underwent endoscopic LND via chest approach between February 2017 and November 2022 were retrospectively reviewed. The surgeon's learning curve was evaluated using a cumulative sum graphic model (CUSUM).
A CUSUM analysis was applied to 53 patients (10 males, 43 females) with a mean age of 41.4 y who underwent endoscopic LND via chest approach. The best model for the curve was determined to be a third-order polynomial equation as follows: CUSUM = - 0.007×patient number-0.666×patient number + 55.721×patient number - 72.964. This equation has a high R value of 0.929. The peak operative time (OT) occurred at the 30th case. Consequently, the learning curve model was divided into two phases: phase 1 (1-30 cases) and phase 2 (31-53 cases). OT (307.9 ± 63.8 min vs. 232.4 ± 44.2 min, respectively; p < 0.001), blood loss (50 mL vs. 20 mL, respectively; p = 0.001), and complications (43.3% vs. 13.0%, respectively; p = 0.038) decreased significantly in phase 2 compared to phase 1.
The learning curve of endoscopic LND via chest approach was found to involve 30 cases. With greater experience, the surgery was completed with shorter OT and fewer complications. This approach may be an alternative for patients who desire cosmesis. Furthermore, the present data and experience insights regarding endoscopic LND via chest approach may help other surgeons to pass the learning phase more safely.
如果外科医生进行了足够数量的手术，使其熟练掌握相关技术，那么内镜侧颈部清扫术（LND）可以成为一种无疤痕手术。在这里，我们检查了一位通过胸部入路进行了 53 例内镜 LND 的外科医生的学习曲线。
回顾性分析了 2017 年 2 月至 2022 年 11 月期间 53 例接受经胸内镜 LND 的甲状腺乳头状癌患者的手术结果。使用累积和图形模型（CUSUM）评估外科医生的学习曲线。
对 53 例（10 例男性，43 例女性）平均年龄为 41.4 岁的患者进行了经胸内镜 LND，应用 CUSUM 分析。最佳曲线模型被确定为三阶多项式方程，如下所示：CUSUM=-0.007×患者数-0.666×患者数+55.721×患者数-72.964。该方程的 R 值为 0.929，具有很高的相关性。手术时间（OT）最长的发生在第 30 例患者。因此，学习曲线模型分为两个阶段：第一阶段（1-30 例）和第二阶段（31-53 例）。第二阶段的 OT（307.9±63.8 min 比 232.4±44.2 min，分别;p<0.001）、出血量（50 mL 比 20 mL，分别;p=0.001）和并发症（43.3%比 13.0%，分别;p=0.038）显著低于第一阶段。
经胸入路内镜 LND 的学习曲线涉及 30 例。随着经验的增加，手术时间更短，并发症更少。这种方法可能是那些希望美容的患者的一种替代选择。此外，本研究中关于经胸内镜 LND 的数据和经验见解可能有助于其他外科医生更安全地通过学习阶段。
