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, 谢秋萍. 腔镜甲状腺手术临床应用争议和共识. 中国实用外科杂志, 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.	张亚坤, 门泉仓, 李霞霞, 等. 胸乳入路腔镜甲状腺手术学习曲线及经验体会. 中国内镜杂志, 2020, 26(5): 48-54.
8.	赵宁, 张翊乔, 王鈢, 等. 全乳晕入路腔镜甲状腺切除术十步法学习曲线. 中华腔镜外科杂志(电子版), 2020, 13(4): 201-206.
9.	胡友主, 李国新, 王存川. 完全乳晕入路腔镜甲状腺切除手术的学习曲线. 暨南大学学报(自然科学与医学版), 2012, 33(6): 597-600.
10.	郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法—葛-郑氏七步法. 中国普通外科杂志, 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.	赖湘敏, 刘博, 孙灿, 等. 以CUSUM方法分析达芬奇机器人肺叶切除术的学习曲线. 中华腔镜外科杂志(电子版), 2018, 11(4): 220-223.
14.	郑传铭, 毛晓春, 王佳峰, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会. 中国肿瘤临床, 2018, 45(1): 27-32.
15.	王佳峰, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术对术后颈部功能影响的初步研究. 中华内分泌外科杂志, 2021, 15(1): 10-14.
16.	孙思雨, 张晨嵩, 谢波, 等. 经腋窝入路免充气全腔镜甲状腺癌根治术和开放甲状腺癌根治术疗效对比. 蚌埠医学院学报, 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.	张斌. 无充气腋窝入路完全腔镜下甲状腺癌根治术安全性及可行性研究. 辽宁医学杂志, 2020, 34(1): 39-41.
19.	胡康, 孙素红, 郑传铭. 改良无充气腋窝入路腔镜甲状(旁)腺手术40例分析. 中国普通外科杂志, 2019, 28(11): 1437-1440.
20.	张浩, 陈延松, 张晓静, 等. 双孔与单孔免充气经腋窝入路腔镜甲状腺手术的应用对比. 腹腔镜外科杂志, 2020, 25(9): 669-672, 682.
21.	徐加杰, 张李卓, 张启弘, 等. 无充气经腋窝腔镜甲状腺手术的临床应用. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10): 913-920.
22.	马冠君, 刘晟, 单成祥, 等. 内镜甲状腺切除术学习曲线不同阶段临床技术指标的评价. 腹腔镜外科杂志, 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, 谢秋萍. 腔镜甲状腺手术临床应用争议和共识. 中国实用外科杂志, 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. 张亚坤, 门泉仓, 李霞霞, 等. 胸乳入路腔镜甲状腺手术学习曲线及经验体会. 中国内镜杂志, 2020, 26(5): 48-54.
8. 赵宁, 张翊乔, 王鈢, 等. 全乳晕入路腔镜甲状腺切除术十步法学习曲线. 中华腔镜外科杂志(电子版), 2020, 13(4): 201-206.
9. 胡友主, 李国新, 王存川. 完全乳晕入路腔镜甲状腺切除手术的学习曲线. 暨南大学学报(自然科学与医学版), 2012, 33(6): 597-600.
10. 郑传铭, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺叶切除的方法—葛-郑氏七步法. 中国普通外科杂志, 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. 赖湘敏, 刘博, 孙灿, 等. 以CUSUM方法分析达芬奇机器人肺叶切除术的学习曲线. 中华腔镜外科杂志(电子版), 2018, 11(4): 220-223.
14. 郑传铭, 毛晓春, 王佳峰, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术效果初步评价初期体会. 中国肿瘤临床, 2018, 45(1): 27-32.
15. 王佳峰, 徐加杰, 蒋烈浩, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术对术后颈部功能影响的初步研究. 中华内分泌外科杂志, 2021, 15(1): 10-14.
16. 孙思雨, 张晨嵩, 谢波, 等. 经腋窝入路免充气全腔镜甲状腺癌根治术和开放甲状腺癌根治术疗效对比. 蚌埠医学院学报, 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. 张斌. 无充气腋窝入路完全腔镜下甲状腺癌根治术安全性及可行性研究. 辽宁医学杂志, 2020, 34(1): 39-41.
19. 胡康, 孙素红, 郑传铭. 改良无充气腋窝入路腔镜甲状(旁)腺手术40例分析. 中国普通外科杂志, 2019, 28(11): 1437-1440.
20. 张浩, 陈延松, 张晓静, 等. 双孔与单孔免充气经腋窝入路腔镜甲状腺手术的应用对比. 腹腔镜外科杂志, 2020, 25(9): 669-672, 682.
21. 徐加杰, 张李卓, 张启弘, 等. 无充气经腋窝腔镜甲状腺手术的临床应用. 中华耳鼻咽喉头颈外科杂志, 2020, 55(10): 913-920.
22. 马冠君, 刘晟, 单成祥, 等. 内镜甲状腺切除术学习曲线不同阶段临床技术指标的评价. 腹腔镜外科杂志, 2011, 16(3): 192-195.

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

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