scholarly journals The Learning Curve of Robotic Thyroid Surgery and the Avoidance of Temporary Hypoparathyroidism after Total Thyroidectomy and Concomitant Central Compartment Node Dissection: A Single Surgeon’s Experience

2019 ◽  
Vol 9 (13) ◽  
pp. 2594
Author(s):  
Jae Park ◽  
Jun Lee ◽  
Jae Won Cho ◽  
Jong Yoon
Keyword(s):  
Learning Curve ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Phase 1 ◽  
Operation Time ◽  
Central Compartment ◽  
Node Dissection ◽  
Initial Learning ◽  
Potential Risk Factors ◽  
Robotic Thyroid Surgery

The aim of this study was to evaluate the learning curve of robotic thyroid surgery with regard to both operation time and temporary hypoparathyroidism using quantitative statistical analysis. A total of 194 patients who underwent total thyroidectomy and concomitant central compartment node dissection for papillary thyroid carcinoma by a single surgeon between December 2008 and September 2017 were enrolled. The learning curve for operation time was assessed using the cumulative sum (CUSUM) technique, and the number of procedures required to reduce the incidence of temporary hypoparathyroidism to less than 30% was determined using the CUSUM and risk-adjusted CUSUM (RA-CUSUM) techniques. The learning curve for operation time was divided into three phases: phase 1 (the initial learning period, 1st–19th cases), phase 2 (the challenging period, 20th–121st cases), and phase 3 (the competent phase, 122nd–194th cases). To reduce the incidence of temporary hypoparathyroidism to <30% required 119 cases, and after adjustment for potential risk factors by RA-CUSUM analysis this extended to 173 cases. Technical proficiency for robotic thyroid surgery with respect to the avoidance of surgical complications probably requires a longer learning period than that required for operation time.

scholarly journals Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery

2019 ◽  
Vol 8 (3) ◽  
pp. 402 ◽  
Author(s):  
HyunGoo Kim ◽  
Hyungju Kwon ◽  
Woosung Lim ◽  
Byung-In Moon ◽  
Nam Sun Paik
Keyword(s):  
Learning Curve ◽  
Quantitative Assessment ◽  
Outcome Measure ◽  
Operation Time ◽  
Robotic Thyroidectomy ◽  
Oncologic Outcomes ◽  
Cumulative Summation ◽  
Robotic Thyroid Surgery ◽  
Transient Hypoparathyroidism ◽  
Ideal Method

With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 ± 27.7 min vs. 166.9 ± 29.5 min; p < 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.

scholarly journals Outcome of robot-assisted pancreaticoduodenectomy during initial learning curve versus laparotomy

2019 ◽  
Author(s):  
Jiangjiao Zhou ◽  
Heng Zou ◽  
Li Xiong ◽  
Xiongying Miao ◽  
Zhongtao Liu ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Learning Curve ◽  
Operative Time ◽  
Operation Time ◽  
Robot Assisted ◽  
Extensive Experience ◽  
Curve Versus ◽  
Initial Learning ◽  
Cusum Method ◽  
Open Pancreaticoduodenectomy

Abstract Background : To analyze the initial learning curve (LC) for robot-assisted pancreaticoduodenectomy (RAPD) and compare RAPD during the initial LC with open pancreaticoduodenectomy (OPD) in terms of outcome. Methods : This study is a retrospective review of patients who consecutively underwent RAPD between October 2015 and May 2019 in our hospital. Experiences from 30 initial consecutive RAPD cases, considered the initial LC of a single surgeon team, were compared with those from laparotomy cases during the same period in terms of outcome. Preoperative demographic and comorbidity data were obtained. Perioperative data on operation time, blood transfusion, numbers of harvested lymph nodes, 90-day mortality and readmission, surgery-related complications, postoperative hospital stay, and total costs were acquired for analysis. The operation time for RAPD was evaluated using the cumulative sum(CUSUM) method. Results : Seventy-eight patients, including 30 consecutive RAPD cases and 48 consecutive open cases, were enrolled for review. The demographic and comorbidity characteristics of the two groups were similar. Compared with OPD, RAPD required a significantly longer operative time (423.67 ± 137.627 min vs. 228.75 ± 44.988 min, P < 0.001) and higher cost (185700 ± 54500 RMB vs. 120600 ± 41700 RMB, P < 0.001). Moreover, compared with the OPD group, the RAPD group revealed a significantly smaller mean number of lymph nodes harvested in malignant cases (8.72 ± 4.9 vs 14.26 ± 7.633, P = 0.007). No statistically significant differences were observed between the two groups in terms of incidence of Clavien–Dindo grade III–V morbidities and 90-day mortality and readmission. In the CUSUM graph, one peak point was observed at the 8th case, after which the operation time began to decrease. Conclusions : RAPD is safe when performed in well-selected patients by well-trained teams with extensive experience in open pancreaticoduodenectomy during the initial LC,and the LC of RAPD may be shorten less than 30 cases.

scholarly journals Ultrasonography of Injury to the Parathyroids During a Thyroidectomy

2019 ◽  
Vol 35 (6) ◽  
pp. 460-464
Author(s):  
Jun-hua Zhang
Keyword(s):  
Lymph Node ◽  
Total Thyroidectomy ◽  
Lymph Node Dissection ◽  
Thyroid Surgery ◽  
Clinical Symptoms ◽  
Parathyroid Glands ◽  
Medical Laboratory ◽  
Case Review ◽  
Node Dissection ◽  
Central Lymph Node Dissection

Objective: Explore the characteristics of parathyroid injury during thyroid surgery and the potential for sonography to reduce the risk of parathyroid injury. Methods: Retrospective analysis was conducted on 39 patient cases, with parathyroid injury (including 29 cases of total thyroidectomy plus central lymph node dissection and 10 cases of total thyroidectomy). Sonography and related medical laboratory testing were performed pre- and postsurgery. Clinical symptoms and associated postsurgical gland changes were compared and analyzed according to the relevant laboratory values. Results: The patient case review demonstrated that the total number of glands decreased by 43 compared with preoperation, with 25 glands in the upper pair and 18 glands in the lower. There were 33 glands with uneven echo and blurred edges, with 20 in the upper pair and 13 in the lower pair. The damage rate of the upper gland (45/76) was higher than that of the lower gland (31/76) ( P < .05). A total of 69.7% (23/33) of gland blood flow signals were reduced compared with preoperation, of which 10 showed uneven enhancement when the contrast-enhanced ultrasound reached its peak. Conclusion: Thyroid surgery can easily damage parathyroid glands, especially during a total thyroidectomy, with lymph node dissection. Sonography of the parathyroid glands in patients with postoperative hypocalcemia can provide imaging surveillance and mitigate the damage of these glands postsurgically.

scholarly journals Incidence and risk factor for short term postoperative cough after thyroidectomy

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Junfu Wu ◽  
Liyuan Dai ◽  
Weihua Lou
Keyword(s):  
Thyroid Surgery ◽  
Prevalence Rate ◽  
Malignant Disease ◽  
Operation Time ◽  
Benign Disease ◽  
Time Operation ◽  
Significant Difference ◽  
Related Quality ◽  
Potential Risk Factors ◽  
The Difference

Abstract Background The prevalence of potential risk factors for postoperative cough after thyroidectomy remain unknown. The current study aimed to research postoperative cough in patients undergoing thyroid surgery prospectively. Methods Adult patients who underwent primary thyroid surgery were selected prospectively. Data regarding age, sex, BMI, pathology and surgical procedure were collected and analyzed. The Leicester Cugh Questionnaire (LCQ) was required to be completed by all patients before operation, 2 weeks and 4 weeks after operation. Results There were 1264 patients enrolled in total. Eleven patients with vocal cord paralysis were excluded. In patients with benign disease, postoperative cough occurred in 61 patients, with an prevalence rate of 17. 0% compared to an prevalence rate of 33.1% in patients with malignant disease; the difference was significant. For benign patients, the factors of smoking and operation time were independently related to the occurrence of postoperative cough. For malignant patients, the factors of smoking, operation time, operation extent, and the number of positive nodes at level 6 were independently related to the occurrence of postoperative cough. There was no significant difference regarding the LCQ score in patients with benign or malignant disease at the preoperative and the postoperative 4-week time periods. Patients with malignant disease had a significantly lower LCQ score than patients with benign disease at the postoperative 2-week time point (p = 0.004). Conclusions Patients undergoing thyroid cancer surgery had a higher incidence of postoperative cough and were also associated with a decreased cough-related quality of life. The factors of smoking and operation time were the most important predictors for postoperative cough after thyroidectomy.

scholarly journals Incidence and risk factor for short term postoperative cough after thyroidectomy

2020 ◽  
Author(s):  
Junfu Wu ◽  
Liyuan Dai ◽  
Weihua Lou
Keyword(s):  
Thyroid Surgery ◽  
Prevalence Rate ◽  
Malignant Disease ◽  
Operation Time ◽  
Benign Disease ◽  
Time Operation ◽  
Significant Difference ◽  
Related Quality ◽  
Potential Risk Factors ◽  
The Difference

Abstract Background: The prevalence of potential risk factors for postoperative cough after thyroidectomy remain unknown. The current study aimed to research postoperative cough in patients undergoing thyroid surgery prospectively.Methods: Adult patients who underwent primary thyroid surgery were selected prospectively. Data regarding age, sex, BMI, pathology and surgical procedure were collected and analyzed. The Leicester Cugh Questionnaire (LCQ) was required to be completed by all patients before operation, 2 weeks and 4 weeks after operation.Results: There were 1264 patients enrolled in total. Eleven patients with vocal cord paralysis were excluded. In patients with benign disease, postoperative cough occurred in 61 patients, with an prevalence rate of 17. 0% compared to an prevalence rate of 33.1% in patients with malignant disease; the difference was significant. For benign patients, the factors of smoking and operation time were independently related to the occurrence of postoperative cough. For malignant patients, the factors of smoking, operation time, operation extent, and the number of positive nodes at level 6 were independently related to the occurrence of postoperative cough. There was no significant difference regarding the LCQ score in patients with benign or malignant disease at the preoperative and the postoperative 4-week time periods. Patients with malignant disease had a significantly lower LCQ score than patients with benign disease at the postoperative 2-week time point (p=0.004).Conclusions: Patients undergoing thyroid cancer surgery had a higher incidence of postoperative cough and were also associated with a decreased cough-related quality of life. The factors of smoking and operation time were the most important predictors for postoperative cough after thyroidectomy.

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