Abstract
With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.
Highlights
Robotic thyroidectomy has been described as an alternative method for removing the thyroid gland without incising the neck
The present study evaluated the learning curve for bilateral axillo-breast approach (BABA) robotic thyroidectomy using operation time and postoperative transient hypoparathyroidism
BABA robotic total thyroidectomy was successful in all patients, and none required conversion to conventional open surgery
Summary
Robotic thyroidectomy has been described as an alternative method for removing the thyroid gland without incising the neck. The bilateral axillo-breast approach (BABA) is one of the more popular techniques for robotic thyroidectomy [1]. Among the various remote-access approaches, BABA has several advantages [2]. BABA provides a symmetrical operative view, which is similar to that of open thyroidectomy. This midline approach allows optimal visualization and dissection for vital structures in both thyroid lobes. BABA affords the largest operative angles for instrument insertion and manipulation, which can minimize instrument fighting or crowding. Evidence of the cosmetic superiority and surgical safety of BABA robotic thyroidectomy has been widely reported [3,4,5]. With the increased utilization of robot thyroidectomy in recent years, surgeon training and proficiency are paramount considerations
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