The Learning Curve for Robotic Thyroidectomy: A Multicenter Study
The Learning Curve for Robotic Thyroidectomy: A Multicenter Study
复制标题
DOI：
10.1245/s10434-010-1220-z
复制
发表时间：
2011-01-01
影响因子：
3.7
通讯作者：
Chung, Woong Youn
中科院分区：
文献类型：
--
作者：
Lee, Jandee;Yun, Jong Ho;Chung, Woong Youn
目的.尚未建立机器人甲状腺切除术联合中央室淋巴结清扫（CCND）的学习曲线。我们研究了机器人甲状腺切除术经验对围手术期参数的影响，以确定学习曲线。学习外科医生的结果进行了比较，有经验的外科医生。我们进行了一项前瞻性、对照、多中心研究，涉及三个学术中心的四名内分泌外科医生。患者在2008年9月至2009年10月期间接受了CCND的机器人甲状腺全切除术或次全切除术。一名外科医生在该技术方面经验丰富（经验丰富的外科医生，ES），而其他三名外科医生具有内窥镜甲状腺手术经验，但没有执行机器人手术的经验（非机器人甲状腺手术经验丰富的外科医生，NS）。结果指标包括人口统计学数据、手术时间、失血量、住院时间、病理结果和术后并发症。共进行了644例CCND的机器人甲状腺全切除术或次全切除术：377例（58.7%）由NS进行，267例（41.5%）由ES进行。NS患者组的平均手术时间长于ES患者组，并发症发生率高于ES患者组（P <0.001）。NS组在甲状腺全切除术50例和甲状腺次全切除术40例的手术时间和并发症发生率与ES组相似。对于经验丰富的内镜甲状腺切除术外科医生，使用无气经腋下入路的CCND机器人甲状腺切除术的学习曲线持续时间为甲状腺全切除术50例，甲状腺次全切除术40例。
Purpose. The learning curve for robotic thyroidectomy with central compartment node dissection (CCND) has not been established. We examined the effect of experience of robotic thyroidectomy on a range of perioperative parameters in order to determine the learning curve. The learner surgeon outcomes were compared with those of an experienced surgeon.Methods. We conducted a prospective, controlled, multicenter study involving four endocrine surgeons at three academic centers. Patients underwent robotic total or subtotal thyroidectomy with CCND between September 2008 and October 2009. One surgeon was experienced in the technique (experienced surgeon, ES), while the other three surgeons had endoscopic thyroid surgery experience but no experience performing the robotic procedure (nonrobotic thyroid surgery experienced surgeon, NS). Outcome measures were demographic data, operative time, blood loss, hospital stay, pathologic results, and postoperative complications.Results. A total of 644 total or subtotal robotic thyroidectomies with CCND were performed: 377 (58.7%) by NSs and 267 (41.5%) by the ES. Mean operative time was longer and the complication rate was higher for the NS patient group compared with the ES patient group (P < .001 for each). The operative times and complications rates for the NS group were similar to those of the ES group once the NSs had performed 50 cases for total thyroidectomies or 40 cases for subtotal thyroidectomies.Conclusion. The learning curve duration for robotic thyroidectomy with CCND using gasless transaxillary approach for experienced endoscopic thyroidectomy surgeons was 50 cases for total thyroidectomy and 40 cases for subtotal thyroidectomy.