Quantitative assessment of the learning curve for bilateral axillo-breast approach robotic thyroid surgery

  • Background
    In the field of robotic surgery, significant interest has been placed on surgeon performance evaluations and the emphasis on safety and outcomes. This study aimed to evaluate the learning curve for bilateral axillo-breast approach (BABA) robotic thyroidectomy using operation time and postoperative transient hypoparathyroidism.

    BABA robotic total thyroidectomy was performed on 172 consecutive patients by a single surgeon between March 2014 and February 2018. Cumulative summation (CUSUM) analysis was used to evaluate the learning curve.

    CUSUM analysis revealed that it took 50 cases for the surgeon to significantly improve operation time. Mean operation time was significantly shorter in the group including the 51st to the 172nd case than in the group including only the first 50 cases (98.0 ± 27.6 min vs. 123.5 ± 29.3 min; p < 0.001). Other clinicopathological factors, including complication rates, showed no differences between the groups.

    Postoperative transient hypoparathyroidism occurred in 78 (45.3%) patients. The incidence of hypoparathyroidism gradually decreased from 52.0% for the first 50 cases to 40.3% for the last 72 cases. CUSUM analysis for transient hypoparathyroidism indicated that the surgeon was competent after the 75th case, demonstrating a longer learning curve than the 50 cases required to improve operation time.

    More experiences are required to achieve proficiency for BABA robotic thyroidectomy when the incidence of transient hypoparathyroidism was used as the marker of proficiency, as opposed to operation time being used. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.


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