Document Detail


Defining the learning curve for video-assisted thyroidectomy.
MedLine Citation:
PMID:  19119087     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM: 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. MATERIALS AND 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.
Authors:
G Dionigi; L Boni; F Rovera; M Annoni; F Villa; R Dionigi
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2008-12-10
Journal Detail:
Title:  International journal of surgery (London, England)     Volume:  6 Suppl 1     ISSN:  1743-9159     ISO Abbreviation:  -     Publication Date:  2008  
Date Detail:
Created Date:  2009-04-06     Completed Date:  2009-05-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101228232     Medline TA:  Int J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  S1-3     Citation Subset:  IM    
Affiliation:
Endocrine Surgery Research Center, Department of Surgical Sciences, University of Insubria, Viale Borri 57, 21100 Varese, Italy. gianlorenzo.dionigi@uninsubria.it
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Clinical Competence / standards*
Education, Medical, Continuing / methods*
Educational Measurement
Feasibility Studies
Female
Follow-Up Studies
Humans
Incidence
Italy / epidemiology
Male
Middle Aged
Postoperative Complications / epidemiology
Prospective Studies
Thyroid Diseases / surgery*
Thyroidectomy / education*,  methods
Time Factors
Video-Assisted Surgery / education*,  methods
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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