The learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xiaofei , LIU Feng , ZHENG Xun , ZHU Jingqiang , LI Zhihui ,  WEI Tao

Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;

Corresponding?author：

WEI Tao, Email: docweitao@sina.com

Keywords：

endoscopy; axillary approach; thyroid cancer; cumulative sum analysis; learning curve

DOI：

10.7507/1007-9424.202104019

Video：

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Objective To explore the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma.Methods We retrospectively analyzed the clinical data of 51 patients diagnosed with papillary thyroid microcarcinoma who underwent an endoscopic thyroidectomy using a gasless unilateral axillary approach by the same surgeon from November 2019 to September 2020 in the Department of Thyroid and Parathyroid Surgery, West China Hospital, Sichuan University. The cumulative sum (CUSUM) analysis was used to determine the learning curve of the technology, and the CUSUM learning curve was modeled by the best fit. The operative time, intraoperative blood loss, number of lymph nodes dissected, incidence of complications and postoperative hospital stay in different phases of the learning curve were compared.Results The CUSUM fitting curve reached the top at the 18th case. As a cut-off point, the learning curve was divided into two stages: the learning improvement period and the proficiency period. The operative time of patients in the proficiency stage was significantly shorter than that in the learning improvement stage (P<0.05), and there were no statistically significant differences in other data of patients in the two stages (P>0.05).Conclusion The CUSUM analysis method is used to accurately analyze the learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma, indicating that the cumulative number of operations required to master this technique is 18 cases.

Citation： WANG Xiaofei, LIU Feng, ZHENG Xun, ZHU Jingqiang, LI Zhihui, WEI Tao. The learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(10): 1270-1274. doi: 10.7507/1007-9424.202104019 Copy

1.	Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA, 2017, 317(13): 1338-1348.
2.	Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA, 2006, 295(18): 2164-2167.
3.	Jiang WJ, Yan PJ, Zhao CL, et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc, 2020, 34(5): 1891-1903.
4.	Jiang ZG, Zhang W, Jiang DZ, et al. Clinical benefits of scarless endoscopic thyroidectomy: an expert’s experience. World J Surg, 2011, 35(3): 553-557.
5.	王平, 謝秋萍. 腔鏡甲狀腺手術臨床應用爭議和共識. 中國實用外科雜志, 2015, 35(1): 76-78.
6.	Tan CT, Cheah WK, Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg, 2008, 32(7): 1349-1357.
7.	張亞坤, 門泉倉, 李霞霞, 等. 胸乳入路腔鏡甲狀腺手術學習曲線及經驗體會. 中國內鏡雜志, 2020, 26(5): 48-54.
8.	趙寧, 張翊喬, 王鈢, 等. 全乳暈入路腔鏡甲狀腺切除術十步法學習曲線. 中華腔鏡外科雜志(電子版), 2020, 13(4): 201-206.
9.	胡友主, 李國新, 王存川. 完全乳暈入路腔鏡甲狀腺切除手術的學習曲線. 暨南大學學報(自然科學與醫學版), 2012, 33(6): 597-600.
10.	鄭傳銘, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺葉切除的方法—葛-鄭氏七步法. 中國普通外科雜志, 2019, 28(11): 1336-1341.
11.	Morató O, Poves I, Burdío F, et al. Evaluation of the learning curve for laparoscopic pancreatoduodenectomy by CUSUM analyses. Cohort study. Int J Surg, 2020, 80: 61-67.
12.	Sultana A, Nightingale P, Marudanayagam R, et al. Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM. HPB (Oxford), 2019, 21(11): 1505-1512.
13.	賴湘敏, 劉博, 孫燦, 等. 以CUSUM方法分析達芬奇機器人肺葉切除術的學習曲線. 中華腔鏡外科雜志(電子版), 2018, 11(4): 220-223.
14.	鄭傳銘, 毛曉春, 王佳峰, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術效果初步評價初期體會. 中國腫瘤臨床, 2018, 45(1): 27-32.
15.	王佳峰, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術對術后頸部功能影響的初步研究. 中華內分泌外科雜志, 2021, 15(1): 10-14.
16.	孫思雨, 張晨嵩, 謝波, 等. 經腋窩入路免充氣全腔鏡甲狀腺癌根治術和開放甲狀腺癌根治術療效對比. 蚌埠醫學院學報, 2021, 46(2): 173-175, 178.
17.	Chung YS, Choe JH, Kang KH, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg, 2007, 31(12): 2302-2306.
18.	張斌. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術安全性及可行性研究. 遼寧醫學雜志, 2020, 34(1): 39-41.
19.	胡康, 孫素紅, 鄭傳銘. 改良無充氣腋窩入路腔鏡甲狀(旁)腺手術40例分析. 中國普通外科雜志, 2019, 28(11): 1437-1440.
20.	張浩, 陳延松, 張曉靜, 等. 雙孔與單孔免充氣經腋窩入路腔鏡甲狀腺手術的應用對比. 腹腔鏡外科雜志, 2020, 25(9): 669-672, 682.
21.	徐加杰, 張李卓, 張啟弘, 等. 無充氣經腋窩腔鏡甲狀腺手術的臨床應用. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(10): 913-920.
22.	馬冠君, 劉晟, 單成祥, 等. 內鏡甲狀腺切除術學習曲線不同階段臨床技術指標的評價. 腹腔鏡外科雜志, 2011, 16(3): 192-195.

1. Lim H, Devesa SS, Sosa JA, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA, 2017, 317(13): 1338-1348.
2. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA, 2006, 295(18): 2164-2167.
3. Jiang WJ, Yan PJ, Zhao CL, et al. Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis. Surg Endosc, 2020, 34(5): 1891-1903.
4. Jiang ZG, Zhang W, Jiang DZ, et al. Clinical benefits of scarless endoscopic thyroidectomy: an expert’s experience. World J Surg, 2011, 35(3): 553-557.
5. 王平, 謝秋萍. 腔鏡甲狀腺手術臨床應用爭議和共識. 中國實用外科雜志, 2015, 35(1): 76-78.
6. Tan CT, Cheah WK, Delbridge L. “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg, 2008, 32(7): 1349-1357.
7. 張亞坤, 門泉倉, 李霞霞, 等. 胸乳入路腔鏡甲狀腺手術學習曲線及經驗體會. 中國內鏡雜志, 2020, 26(5): 48-54.
8. 趙寧, 張翊喬, 王鈢, 等. 全乳暈入路腔鏡甲狀腺切除術十步法學習曲線. 中華腔鏡外科雜志(電子版), 2020, 13(4): 201-206.
9. 胡友主, 李國新, 王存川. 完全乳暈入路腔鏡甲狀腺切除手術的學習曲線. 暨南大學學報(自然科學與醫學版), 2012, 33(6): 597-600.
10. 鄭傳銘, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺葉切除的方法—葛-鄭氏七步法. 中國普通外科雜志, 2019, 28(11): 1336-1341.
11. Morató O, Poves I, Burdío F, et al. Evaluation of the learning curve for laparoscopic pancreatoduodenectomy by CUSUM analyses. Cohort study. Int J Surg, 2020, 80: 61-67.
12. Sultana A, Nightingale P, Marudanayagam R, et al. Evaluating the learning curve for laparoscopic liver resection: a comparative study between standard and learning curve CUSUM. HPB (Oxford), 2019, 21(11): 1505-1512.
13. 賴湘敏, 劉博, 孫燦, 等. 以CUSUM方法分析達芬奇機器人肺葉切除術的學習曲線. 中華腔鏡外科雜志(電子版), 2018, 11(4): 220-223.
14. 鄭傳銘, 毛曉春, 王佳峰, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術效果初步評價初期體會. 中國腫瘤臨床, 2018, 45(1): 27-32.
15. 王佳峰, 徐加杰, 蔣烈浩, 等. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術對術后頸部功能影響的初步研究. 中華內分泌外科雜志, 2021, 15(1): 10-14.
16. 孫思雨, 張晨嵩, 謝波, 等. 經腋窩入路免充氣全腔鏡甲狀腺癌根治術和開放甲狀腺癌根治術療效對比. 蚌埠醫學院學報, 2021, 46(2): 173-175, 178.
17. Chung YS, Choe JH, Kang KH, et al. Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg, 2007, 31(12): 2302-2306.
18. 張斌. 無充氣腋窩入路完全腔鏡下甲狀腺癌根治術安全性及可行性研究. 遼寧醫學雜志, 2020, 34(1): 39-41.
19. 胡康, 孫素紅, 鄭傳銘. 改良無充氣腋窩入路腔鏡甲狀(旁)腺手術40例分析. 中國普通外科雜志, 2019, 28(11): 1437-1440.
20. 張浩, 陳延松, 張曉靜, 等. 雙孔與單孔免充氣經腋窩入路腔鏡甲狀腺手術的應用對比. 腹腔鏡外科雜志, 2020, 25(9): 669-672, 682.
21. 徐加杰, 張李卓, 張啟弘, 等. 無充氣經腋窩腔鏡甲狀腺手術的臨床應用. 中華耳鼻咽喉頭頸外科雜志, 2020, 55(10): 913-920.
22. 馬冠君, 劉晟, 單成祥, 等. 內鏡甲狀腺切除術學習曲線不同階段臨床技術指標的評價. 腹腔鏡外科雜志, 2011, 16(3): 192-195.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The learning curve of endoscopic thyroidectomy using the gasless unilateral axillary approach for papillary thyroid microcarcinoma

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