Deng Yuhang, Zhao Jiaojiao, Tao Mei, Zhao Haixin, Fan Ruoxin, Wang Xiaoming, Lu Xiubo
Department of Thyroid Surgery, Zhengzhou University First Affiliated Hospital, Zhengzhou, Henan, China.
Oncology Department, Tianjin Medical University, Tianjin, China.
Front Endocrinol (Lausanne). 2025 Jan 6;15:1498797. doi: 10.3389/fendo.2024.1498797. eCollection 2024.
The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is distinguished by its ability to leave no visible scars on the body's surface. Currently, there is still a lack of single-center large sample size analysis on the learning curve of TOETVA, especially for the treatment of thyroid cancer. This study aims to fill this void by presenting a comprehensive analysis of the learning curve and assessing the procedure's feasibility in managing thyroid cancer.
Between June 2020 and June 2023, a retrospective analysis was conducted on 195 patients who had undergone the transoral endoscopic thyroidectomy vestibular approach (TOETVA) at the First Affiliated Hospital of Zhengzhou University. We employed the cumulative sum method (CUSUM) to delineate the learning curve of TOETVA. Additionally, clinical parameters across different stages of the learning process were meticulously compared and analyzed.
All patients successfully completed endoscopic surgery without conversion to open surgery. Utilizing the CUSUM algorithm, two distinct learning phases were delineated: the exploration phase, comprising 58 cases, and the maturation phase, encompassing 137 cases. Analysis revealed that the maturation phase demonstrated significantly reduced operative times (189.7 ± 237.27 . 138.15 ± 26.62 minutes, p<0.001), decreased blood loss (15.49 ± 15.05 . 9.67 ± 4.12 ml, p=0.005), and a lower incidence of complications (7 . 4, p=0.028) when compared to the exploration phase. Additionally, in the maturation phase, we achieved successful surgical outcomes in a subset of obese patients and those with nodular goiter.
TOETVA has been demonstrated to be safe and feasible, with the capability to effectively address complex cases once the learning curve has been surmounted.
经口内镜甲状腺手术前庭入路（TOETVA）的特点是体表不留可见瘢痕。目前，对于TOETVA学习曲线，尤其是在甲状腺癌治疗方面，仍缺乏单中心大样本量分析。本研究旨在通过全面分析学习曲线并评估该手术在治疗甲状腺癌中的可行性来填补这一空白。
2020年6月至2023年6月，对郑州大学第一附属医院195例行经口内镜甲状腺手术前庭入路（TOETVA）的患者进行回顾性分析。我们采用累积和法（CUSUM）来描绘TOETVA的学习曲线。此外，还对学习过程不同阶段的临床参数进行了细致的比较和分析。
所有患者均成功完成内镜手术，无需转为开放手术。利用CUSUM算法，确定了两个不同的学习阶段：探索阶段，共58例；成熟阶段，共137例。分析显示，与探索阶段相比，成熟阶段的手术时间显著缩短（189.7±27.27. 138.15±26.62分钟，p<0.001），失血量减少（15.49±15.05. 9.67±4.12毫升，p=0.005），并发症发生率降低（7. 4，p=0.028）。此外，在成熟阶段，我们在一部分肥胖患者和结节性甲状腺肿患者中取得了成功的手术结果。
TOETVA已被证明是安全可行的，一旦克服学习曲线，有能力有效处理复杂病例。
