Learning Curve for Endoscopic Thyroidectomy Using Video-Assisted Neck Surgery: Retrospective Analysis of a Surgeon's Experience with 100 Patients
| Autor: | Mami Matsui, Iwao Sugitani, Kazuo Shimizu, Takehito Igarashi, Ritsuko Okamura, Hiroko Kazusaka, Tomoo Jikuzono, Masaomi Sen, Ryuta Nagaoka, Marie Saitou |
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| Rok vydání: | 2022 |
| Předmět: |
Adult
Male medicine.medical_specialty endocrine system diseases Video-Assisted Surgery Thyroid carcinoma Paralysis medicine Recurrent laryngeal nerve Retrospective analysis Humans Thyroid Neoplasms Retrospective Studies Surgeons business.industry Thyroid General Medicine Single surgeon Surgery Dissection medicine.anatomical_structure Endoscopic thyroidectomy Thyroidectomy Neck Dissection Female medicine.symptom business Vocal Cord Paralysis Learning Curve |
| Zdroj: | Journal of Nippon Medical School. 89:277-286 |
| ISSN: | 1347-3409 1345-4676 |
| Popis: | Background Endoscopic thyroidectomy offers excellent cosmetic outcomes, but requires a period of time for surgeons to become proficient. We examined the learning curve for the first 100 cases experienced by a single surgeon using a video-assisted neck surgery (VANS) subclavian approach. Methods We retrospectively studied 100 patients (99 women, 1 man; mean age, 36.2 years) with both benign and malignant thyroid diseases treated between 2016 and 2020. Results Preoperative diagnosis was papillary thyroid carcinoma (PTC) in 36 cases and other (non-PTC) in 64 cases. All patients underwent lobectomy, with unilateral central node dissection added for patients with PTC. Mean operative time was 125 min for non-PTC cases and 129 min for PTC cases (p = 0.43), with blood loss of 33.8 ml and 7.6 ml, respectively (p = 0.01). Recurrent laryngeal nerve paralysis (RNP) was observed in 12 patients (12%) and hemorrhage in 2 patients (2%). Comparing the first 30 cases with the last 70 cases, no significant differences in operative time or blood loss were evident, although tumor size of non-PTC cases was significantly greater among later cases (32.4 mm vs. 39.5 mm, p = 0.039). RNP was significantly decreased in later cases (26.7% vs. 5.7%, p = 0.003). Multivariate analysis revealed tumor size as a significant risk factor for increased blood loss, and increased experience correlated significantly with the decrease in RNP. Conclusions In VANS, a certain surgical level was reached after experiencing 30 cases. |
| Databáze: | OpenAIRE |
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