Initial learning curve of single-incision transaxillary robotic hemi- and total thyroidectomy--A single team experience from Europe.
BACKGROUND
The primary advantage of robotic thyroidectomy is to avoid a neck scar. On the other hand, this sophisticated technique implies some potential risks otherwise not associated with conventional thyroidectomy, increased costs, and prolonged operating times. With all these factors being an important issue, we analysed the data of our initial European series in order to understand the nature of the learning curve for this technique.


METHODS
Ten patients underwent transaxillary robotic thyroidectomy for benign disease, performed consistently by the same surgeon with the same team, within a timeframe of 12 months. There were four total thyroidectomies and six hemithyroidectomies. Operating times broken down into creating the working space, docking the robot, and console work (including wound closure), were prospectively recorded and evaluated.


RESULTS
By the end of the initial learning curve comprising ten patients, the total operating time for a robotic hemithyroidectomy and for a total thyroidectomy has decreased by 49% to 190 min, and by 31% to 229 min, respectively. Intraoperative complications were successfully managed without conversion to open access surgery.


CONCLUSIONS
The learning curve for transaxillary robotic thyroidectomy is rather steep; reasonable progress in terms of operating times can be achieved within the first ten cases. Consistency in the team and careful patient selection are paramount factors for success.
Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Dept. of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany. Electronic address: b.loerincz@uke.de.
Balazs B
BB
Lörincz
Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Dept. of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
Chia-Jung
CJ
Busch
Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Dept. of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
Nikolaus
N
Möckelmann
Head and Neck Cancer Center of the Hubertus Wald University Cancer Center Hamburg, Dept. of Otorhinolaryngology, Head & Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany. Electronic address: r.knecht@uke.de.
Rainald
R
Knecht
D000328:Adult; D001365:Axilla; D002118:Calcium / Q000097:blood; D002921:Cicatrix / Q000517:prevention & control; D004502:Education, Medical, Continuing / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010281:Parathyroid Hormone / Q000097:blood; D065287:Robotic Surgical Procedures / Q000193:education / Q000379:methods*; D013965:Thyroidectomy / Q000009:adverse effects / Q000193:education / Q000379:methods*
D010281:Parathyroid Hormone; D002118:Calcium
Learning curve; Robotic thyroidectomy; Transaxillary robotic surgery (TARS)