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Learning Curve for Endoscopic Thyroidectomy Using Video-Assisted Neck Surgery: Retrospective Analysis of a Surgeon's Experience with 100 Patients

Ryuta Nagaoka, Iwao Sugitani, Hiroko Kazusaka, Mami Matsui, Masaomi Sen, Marie Saitou, Tomoo Jikuzono, Ritsuko Okamura, Takehito Igarashi and Kazuo Shimizu

Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan

Background: Endoscopic thyroidectomy offers excellent cosmetic outcomes but requires some time for surgeons to become proficient. We examined the learning curve for the first 100 patients treated by a single surgeon using a subclavian approach for video-assisted neck surgery (VANS).
Methods: We retrospectively studied the records of 100 patients (99 women, 1 man; mean age, 36.2 years) with either benign or malignant thyroid disease treated between 2016 and 2020.
Results: Preoperative diagnosis was papillary thyroid carcinoma (PTC) in 36 cases and other (non-PTC) in 64 cases. All patients underwent lobectomy, with additional unilateral central node dissection for patients with PTC. Mean operative time was 125 min for non-PTC cases and 129 min for PTC cases (p = 0.43); blood loss was 33.8 mL and 7.6 mL, respectively (p = 0.01). Recurrent laryngeal nerve paralysis (RNP) was observed in 12 patients (12%) and hemorrhage in 2 patients (2%). In a comparison of the first 30 cases and subsequent 70 cases, no significant differences in operative time or blood loss were evident, although tumor size was significantly greater among later non-PTC cases (32.4 mm vs. 39.5 mm, p = 0.039). RNP was significantly lower in later cases (26.7% vs. 5.7%, p = 0.003). Multivariate analysis revealed that tumor size was a significant risk factor for increased blood loss, and increased experience significantly correlated with a decrease in RNP.
Conclusions: In VANS, satisfactory surgical proficiency was reached after treating 30 patients.

J Nippon Med Sch 2022; 89: 277-286

Keywords
endoscopic thyroidectomy, gasless lifting method, learning curve, video-assisted neck surgery, papillary thyroid carcinoma

Correspondence to
Ryuta Nagaoka, MD, Department of Endocrine Surgery, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
ryuta-n@nms.ac.jp

Received, May 24, 2021
Accepted, August 4, 2021