The Learning Curve for Transoral Endoscopic Thyroid Surgery: A Single Surgeon's 204 Case Experience

Background: Endoscopic intervention through the natural foramen is becoming more and more interesting because of surgical treatment without any incision of the skin. In our center, transoral endoscopic thyroid surgery through vestibular approach (TOETVA) thyroid surgery may provide excellent results from a cosmetic viewpoint, which requires a learning curve. Generally, learning curve research for TOETVA could be benefit for investigating the surgical outcome for thyroid operation. Methods: This retrospective study investigated 204 consecutive patients, who underwent TOETVA performed by a single thyroid surgeon from November 2014 to June 2017. We divided the patients into hemithyroidectomy and total thyroidectomy, benign and malignant group. These groups were analyzed in terms of cut-suture time (CST) and cumulative sum (CUSUM) analysis, while accompanied with patient characteristics, perioperative clinical results, and operation-related complications. Results and Conclusions: The average CST of 204 cases was 147.99 +/- 43.67 minutes. We observed that TOETVA enables a rapidly decreasing mean operative time after 40-50 cases to reach stabilized CST. Also, we compared the learning curve and CUSUM of the hemithyroidectomy and total thyroidectomy group, benign and malignant group, respectively.