Defining the learning curve for video-assisted thyroidectomy.
OBJECTIVE
Several studies have demonstrated that endoscopic thyroidectomy is a safe technique. Aim of the study is to evaluate the feasibility of video-assisted thyroidectomy (VAT) performed by a junior surgeon.


METHODS
We consider 67 consecutive standard VAT gasless approaches. VAT was performed by an under 35-years-old surgeon trained in basic laparoscopy tutored by an experienced surgeon. Outcome measures were operative and hospitalization times, incision length, and complications. Conversion to open surgery was defined as the need to perform a longer incision. To establish the number of procedures required before achieving a safe VAT technique, procedures were divided into three chronological groups of about 30 lobectomies (Groups 1, 2, and 3).


RESULTS
Success rates of VAT were 90% in group 1, 97% group 2, 100% group 3 respectively (P<0.05). Most conversions were due to bleeding. In group 1, the overall mean operative time was 111 min, group 2, 93 min, group 3, 86 min (P<0.03). Mean length of incision significantly increased from the initial incision: group 1, +1.3 cm, group 2, +0.9, group 3, +0.5 cm (P>0.05). Group 3 had a faster recovery after surgery. The incidences of temporary hypoparathyroidism were 8.9%. The incidences of temporary RLN injury were 2.9%.


CONCLUSIONS
To date there are no recommendations regarding the amount of endoscopic training required to safely perform VAT, but our experience demonstrated that surgeon's age cannot be considered having a negative effects on results. Success of VAT technique was considerably associated with experience: improved operative variables and safe technique were seen after 30 lobectomies.
Dionigi
G
G
Endocrine Surgery Research Center, Department of Surgical Sciences, University of Insubria, Viale Borri 57, 21100 Varese, Italy. gianlorenzo.dionigi@uninsubria.it
Boni
L
L
Rovera
F
F
Annoni
M
M
Villa
F
F
Dionigi
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards*; D004502:Education, Medical, Continuing / Q000379:methods*; D004521:Educational Measurement; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000193:education* / Q000379:methods; D013997:Time Factors; D020535:Video-Assisted Surgery / Q000193:education* / Q000379:methods; D055815:Young Adult