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The Thyroid Gland01:23

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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
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Learning Curve for Transoral Endoscopic Thyroid Lobectomy.

Christopher R Razavi1, Elya Vasiliou1, Ralph P Tufano1

  • 11 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|August 22, 2018
PubMed
Summary

This study determined the learning curve for transoral endoscopic thyroidectomy via the vestibular approach (TOETVA), finding that proficiency was achieved after 11 cases. This indicates a relatively short learning period for mastering TOETVA, a minimally invasive thyroid surgery technique.

Keywords:
remote-access thyroidectomysurgical skill acquisitiontransoral thyroidectomy

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Area of Science:

  • Endocrine Surgery
  • Minimally Invasive Surgery
  • Surgical Education

Background:

  • Transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) is a minimally invasive technique for thyroidectomy.
  • Defining the learning curve is crucial for surgeon training and patient safety.

Purpose of the Study:

  • To establish the learning curve for TOETVA.
  • To identify the number of cases required for a surgeon to achieve proficiency in TOETVA.

Main Methods:

  • A case series of 30 patients undergoing TOETVA was analyzed.
  • Operative time was used as a surrogate for proficiency, plotted against case number.
  • A simple moving average and linear regression were used to define the proficiency case.

Main Results:

  • The proficiency case for TOETVA was identified as case 11.
  • Significant differences were observed in operative time slopes between the skill acquisition and proficiency periods (-16.7 vs -0.3, P < .001).
  • Median operative times decreased significantly from 191 minutes to 119 minutes (P < .001).

Conclusions:

  • The learning curve for TOETVA was determined to be 11 cases for the surgeon studied.
  • Proficiency in TOETVA can be achieved relatively quickly, with significant improvements in operative time and technique.