A Single Surgeon's 10-Year Experience in Remote-Access Thyroid and Parathyroid Surgery

Area of Science:

• Endocrine Surgery
• Minimally Invasive Procedures
• Surgical Education

Background:

• Remote-access thyroid and parathyroid surgery offers scarless neck outcomes.
• Existing techniques are primarily Asian-based, necessitating North American adaptation.
• Understanding the learning curve is crucial for safe implementation.

Purpose of the Study:

• To evaluate the learning curve for remote-access endocrine surgery in a North American setting.
• To identify key performance indicators for mastering these techniques.
• To inform training protocols for endocrine surgeons.

Main Methods:

• Retrospective cohort study of 372 procedures over 10 years.
• Analysis of transaxillary, retroauricular, and transoral endoscopic vestibular approaches.
• Cumulative sum (CUSUM) analysis of operative times and blood loss to define learning phases.

Main Results:

• Transaxillary approach operative times improved after 69 and 134 cases.
• Retroauricular approach showed significant time reduction after 21 cases.
• High same-day discharge rates (57%) achieved during the mastering phase; one brachial plexus injury noted before SSEP monitoring.

Conclusions:

• Remote-access endocrine surgery is safe and effective in select North American patients.
• Learning curve analysis is vital for structuring safe and efficient training.
• This study provides a framework for endocrine surgeons adopting scarless surgical techniques.