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Hand-side matching in TOETVA: assessing feasibility and surgical outcomes through learning curve and propensity
Xiaoyong Wen1,2, Wu Li1, Shiwei Zhou1
1Department of Thyroid Surgery, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, No. 238Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China.
Objective:
To address the lack of guidance for operating the non-dominant side in TOETVA by assessing whether non-dominant-hand TOETVA on the non-dominant side (left hand-left lobe) is a feasible strategy with similar surgical outcomes compared with the conventional dominant-hand approach (right hand-right lobe).
Methods:
This is a single-center, single-surgeon retrospective cohort. Consecutive unilateral TOETVA cases (August 2016-August 2020) were included. Patients were grouped as NDH-TOETVA (left hand on the left lobe) or DH-TOETVA (right hand on the right lobe). Learning curves were segmented using cumulative sum (CUSUM) of operative time into Phase I (initial), Phase II (adaptation), and Phase III (mastery). Phase III outcomes were compared after 1:1 propensity score matching (PSM) on key covariates.
Results:
CUSUM identified distinct phase boundaries: DH-TOETVA Phase I cases 1-13, Phase II 14-54, Phase III ≥ 55; NDH-TOETVA Phase I 1-17, Phase II 18-37, and Phase III ≥ 38. After PSM in Phase III, 176 patients were analyzed (NDH 88 cases, DH 88 cases). Post-match baseline characteristics were balanced. There were no significant differences between NDH and DH in operative time, estimated blood loss, central neck lymph nodes retrieved/positive, length of stay, postoperative drainage, and complications (P > 0.05).
Conclusions:
Hand-side matching is a feasible strategy with compared surgical outcomes in TOETVA. Findings support incorporating this strategy and bilateral-hand training into standardized practice with phase-based, objective assessment.
Trial Registration Number:
Chinese Clinical Trial Registry (UIN: ChiCTR2500097005, https://www.chictr.org.cn ), 2025.2.11.