title: Robotic thyroidectomy learning curve for beginning surgeons with little or no experience of endoscopic surgery.
abstract: BACKGROUND
  This study assessed the results of robotic thyroidectomy by fellowship-trained surgeons in their initial independent practice, and whether standard fellowship training for robotic surgery shortens the learning curve.
  
  
  METHODS
  This prospective cohort study evaluated outcomes in 125 patients who underwent robotic thyroidectomy using gasless transaxillary single-incision technique by 2 recently graduated fellowship-trained surgeons. Learning curves were analyzed by operation time, with proficiency defined as the point at which the slope of the time curve became less steep.
  
  
  RESULTS
  Of the 125 patients, 113 underwent robotic less-than-total thyroidectomy, 9 underwent robotic total thyroidectomy and 3 underwent robotic total thyroidectomy with modified radical neck dissection. Mean total times for these 3 operations were 100.8 ± 20.6 minutes, 134.2 ± 38.7 minutes, and 284.7 ± 60.4 minutes, respectively. For both surgeons, the operation times gradually decreased, reaching a plateau after 20 robotic less-than-total thyroidectomies.
  
  
  CONCLUSIONS
  The surgical learning curve for robotic thyroidectomy performed by recently graduated fellowship-trained surgeons with little or no experience in endoscopic surgery showed excellent results compared with those in a large series of more experienced surgeons.
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Kangwon, Korea.
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jandee
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Surgery, Putrajaya Hospital, Putrajaya, Malaysia.
authors.forename: Nor Azham
authors.initials: NA
authors.lastname: Hakim
authors.affiliation: Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ha Yan
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang-Wook
authors.initials: SW
authors.lastname: Kang
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jong Ju
authors.initials: JJ
authors.lastname: Jeong
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kee-Hyun
authors.initials: KH
authors.lastname: Nam
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Kangwon, Korea.
authors.forename: Keum-Seok
authors.initials: KS
authors.lastname: Bae
authors.affiliation: Department of Surgery, Yonsei University Wonju College of Medicine, Kangwon, Korea.
authors.forename: Seong Joon
authors.initials: SJ
authors.lastname: Kang
authors.affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Woong Youn
authors.initials: WY
authors.lastname: Chung
mesh_terms: D000328:Adult; D015992:Body Mass Index; D061887:Conversion to Open Surgery; D005257:Fellowships and Scholarships; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: beginners; learning curve; robot; robot training; robotic thyroidectomy; thyroidectomy; trainee; trainer; training program