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Learning curve for endoscope holder in endoscopic thyroidectomy via complete areola approach: a prospective study

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Abstract

Background

Endoscopic thyroidectomy via complete areola approach (ETCAA) is becoming the preferred choice of some patients due to the perfect cosmetic result. Endoscope holder plays an important role in the procedures. Research on the learning curve is helpful in training of endoscope holder and improvement of the whole procedure.

Methods

This prospective study investigated 100 consecutive patients who underwent ETCAA performed by a single experienced surgeon and a single inexperienced endoscope holder. Patients were equally divided into ten groups chronologically. One-way analysis of variance, Student–Newman–Keuls test, and Pearson Chi square test were used to analyze statistical significance for clinical data. The correlativity between the operative time and the case number, the endoscope holding score and the case number, the operative time and the interval of neighboring procedures, the endoscope holding score and the interval of neighboring procedures were analyzed with linear regression analysis.

Results

The mean operative time was 96.30 ± 13.10 min, and the mean endoscope holding score was 74.65 ± 14.08. There were significant differences among the mean operative time (P < 0.0001) and the mean endoscope holding score (P < 0.0001). Multiple comparison revealed that the mean operative time of group 7, 8, 9, 10 were shorter than group 4, 5, 6, meanwhile the mean operative time of group 4, 5, 6 were shorter than group 1, 2, 3. Moreover, the mean endoscope holding score of group 7, 8, 9, 10 were higher than group 4, 5, 6, and the mean endoscope holding score of group 4, 5, 6 were higher than group 1, 2, 3. Linear regression analysis showed negative correlation between the operative time and the case number (r = −0.746, P < 0.0001), positive correlation between the endoscope holding score and the case number (r = 0.765, P < 0.0001), positive correlation between the operative time and the interval of neighboring procedures (r = 0.777, P = 0.008), and negative correlation between the endoscope holding score and the interval of neighboring procedures (r = −0.809, P = 0.005).

Conclusion

A specific learning curve for endoscope holder in ETCAA does exist. The initial 30 cases composed the infancy of the learning curve, and the endoscope holder could expect a learning curve of approximately 60 cases in order to achieve proficiency. Increasing the operating frequency would help shorten the learning curve.

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References

  1. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    Article  CAS  PubMed  Google Scholar 

  2. Hüscher C, Chiodini S, Napolitano C, Recher A (1997) Endoscopic right thyroid lobectomy. Surg Endosc 11:877

    Article  PubMed  Google Scholar 

  3. Miccoli P, Pinchera A, Cecchini G, Conte M, Bendinelli C, Vignali E, Picone A, Marcocci C (1997) Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism. J Endocrinol Invest 20:429–430

    Article  CAS  PubMed  Google Scholar 

  4. Shimizu K, Akira S, Jasmi AY, Kitamura Y, Kitagawa W, Akasu H, Tanaka S (1999) Video-assisted neck surgery: endoscopic resection of thyroid tumors with a very minimal neck wound. J Am Coll Surg 188:697–703

    Article  CAS  PubMed  Google Scholar 

  5. Beisša V, Sileikis A, Eismontas V, Strupas K (2012) Video-assisted loboisthmectomy by the subclavicular approach. A case report. Wideochir Inne Tech Malo Inwazyjne 7:206–209

    PubMed Central  PubMed  Google Scholar 

  6. Ikeda Y, Takami H, Sasaki Y, Kan S, Niimi M (2000) Endoscopic resection of thyroid tumors by the axillary approach. J Cardiovasc Surg 41:791–792

    CAS  Google Scholar 

  7. Kiriakopoulos A, Linos D (2012) Gasless transaxillary robotic versus endoscopic thyroidectomy: exploring the frontiers of scarless thyroidectomy through a preliminary comparison study. Surg Endosc 26:2797–2801

    Article  PubMed  Google Scholar 

  8. Ohgami M, Ishii S, Arisawa Y, Ohmori T, Noga K, Furukawa T, Kitajima M (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4

    CAS  PubMed  Google Scholar 

  9. Li Z, Wang P, Wang Y, Xu S, Cao L, Que R, Zhou F (2011) Endoscopic lateral neck dissection via breast approach for papillary thyroid carcinoma: a preliminary report. Surg Endosc 25:890–896

    Article  PubMed  Google Scholar 

  10. Wang CC, Hu YZ, Lai ZW, Yang JG, Chen J, Pan YL, Xu P, Li JY (2009) Endoscopic thyroidectomy via the areola of breast approach. Zhonghua Wai Ke Za Zhi 47:1067–1069

    PubMed  Google Scholar 

  11. Lu JH, Materazzi G, Miccoli M, Baggiani A, Hu S, Miccoli P (2012) Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach: a retrospective analysis of safety, postoperative recovery, and patient satisfaction. Minerva Chir 67:31–37

    CAS  PubMed  Google Scholar 

  12. Yamashita H, Watanabe S, Koike E, Ohshima A, Uchino S, Kuroki S, Tanaka M, Noguchi S (2002) Video-assisted thyroid lobectomy through a small wound in the submandibular area. Am J Surg 183:286–289

    Article  PubMed  Google Scholar 

  13. Wilhelm T, Metzig A (2010) Video. Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc 24:1757–1758

    Article  PubMed  Google Scholar 

  14. Wang C, Zhai H, Liu W, Li J, Yang J, Hu Y, Huang J, Yang W, Pan Y, Ding H (2013) Thyroidectomy: a novel endoscopic oral vestibular approach. Surgery. doi:10.1016/j.surg.2013.06.010

    Google Scholar 

  15. Cao F, Xie B, Cui B, Xu D (2011) Endoscopic vs. conventional thyroidectomy for the treatment of benign thyroid tumors: a retrospective study of a 4 year experience. Exp Ther Med 2:661–666

    PubMed Central  PubMed  Google Scholar 

  16. Chung YS, Choe JH, Kang KH, Kim SW, Chung KW, Park KS, Han W, Noh DY, Oh SK, Youn YK (2007) Endoscopic thyroidectomy for thyroid malignancies: comparison with conventional open thyroidectomy. World J Surg 31:2302–2306

    Article  PubMed  Google Scholar 

  17. Perigli G, Cortesini C, Qirici E, Boni D, Cianchi F (2008) Clinical benefits of minimally invasive techniques in thyroid surgery. World J Surg 32:45–50

    Article  PubMed  Google Scholar 

  18. Leong S, Cahill RA, Mehigan BJ, Stephens RB (2007) Considerations on the learning curve for laparoscopic colorectal surgery: a view from the bottom. Int J Colorectal Dis 22:1109–1115

    Article  CAS  PubMed  Google Scholar 

  19. Ahlberg G, Kruuna O, Leijonmarck CE, Ovaska J, Rosseland A, Sandbu R, Strömberg C, Arvidsson D (2005) Is the learning curve for laparoscopic fundoplication determined by the teacher or the pupil? Am J Surg 189:184–189

    Article  PubMed  Google Scholar 

  20. Gill J, Booth MI, Stratford J, Dehn TC (2007) The extended learning curve for laparoscopic fundoplication: a cohort analysis of 400 consecutive cases. J Gastrointest Surg 11:487–492

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Ozturk E, da Luz Moreira A, Vogel JD (2010) Hand-assisted laparoscopic colectomy: the learning curve is for operative speed, not for quality. Colorectal Dis 12:304–309

    Article  Google Scholar 

  22. Moore MJ, Bennett CL (1995) The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. Am J Surg 170:55–59

    Article  CAS  PubMed  Google Scholar 

  23. Schlachta CM, Mamazza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC (2001) Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 44:217–222

    Article  CAS  PubMed  Google Scholar 

  24. Zhang X, Tanigawa N (2009) Learning curve of laparoscopic surgery for gastric cancer, a laparoscopic distal gastrectomy-based analysis. Surg Endosc 23:1259–1264

    Article  PubMed  Google Scholar 

  25. Cao F, Jin K, Cui B, Xie B (2013) Learning curve for endoscopic thyroidectomy: a single teaching hospital study. Onco Targets Ther 6:47–52

    PubMed Central  PubMed  Google Scholar 

  26. Liu S, Qiu M, Jiang DZ, Zheng XM, Zhang W, Shen HL, Shan CX (2009) The learning curve for endoscopic thyroidectomy: a single surgeon’s experience. Surg Endosc 23:1802–1806

    Article  PubMed  Google Scholar 

  27. Hu YZ, Wang CC, Li GX (2012) Learning curve of endoscopic thyroidectomy by complete areola approach. J Jinan Univ 33:597–600

    Google Scholar 

  28. Ebbinghaus H (1913) Memory: a contribution to experimental psychology. Columbia University, New York

    Book  Google Scholar 

Download references

Acknowledgments

This work was supported by the Suitable Health Technology Promotion Program from Guangdong Provincial Health Bureau (2011-108-11), and Outstanding Postgraduate Research and Innovation Program from Jinan University (2014).

Disclosures

Drs. Junjie Liang, Youzhu Hu, Qiong Zhao, and Qiang Li have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Minimally Invasive Surgery, First Affiliated Hospital of Jinan University, NO.613 Huangpu Road, West, Guangzhou, 510630, Guangzhou, China

    Junjie Liang, Youzhu Hu, Qiong Zhao & Qiang Li

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  1. Junjie Liang
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  2. Youzhu Hu
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  3. Qiong Zhao
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  4. Qiang Li
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Correspondence to Youzhu Hu.

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Liang, J., Hu, Y., Zhao, Q. et al. Learning curve for endoscope holder in endoscopic thyroidectomy via complete areola approach: a prospective study. Surg Endosc 29, 1920–1926 (2015). https://doi.org/10.1007/s00464-014-3885-z

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  • DOI: https://doi.org/10.1007/s00464-014-3885-z

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