The learning curve and its influence factors of the modified Miccoli mode endoscopic thyroidectomy / 重庆医科大学学报

ABSTRACT

Objective:To evaluate the operative time,blood loss,conversion rate toopen surgery,and operative complications formodi-fied Miccoli mode endoscopic thyroidectomy at different stages,under different surgical conditions and with diffrent techniques,in order to explore the learning curve of modified Miccoli mode endoscopic thyroidectomy and its influence factors.Methods:Clinical data of 362 operative cases of benign thyroid tumore performed between June 2005 and June2008 by a single doctor were reviewed.The patients were sequentially divided into three groups,with 30 cases in each group(without considering the size and site of the mass).The operative time,blood loss,conversion rate to open surgery and operative complications were compared between the three groups.Results:The op-erative time in group A,group B and group C were(104.3?29.6)min,(79.5?21.9)min,and(73.67?17.6)min,respectively.There were significant differences in operative time,between the three groups.2 patients in group A converted to open surgery for blood loss,and 1 patient had a temporary injury of recurrent laryngeal nerves.There were significant differences blood loss between the three groups.The influencing factors were as follows.The operative time for the masses of 2 to 4 centimeters was significantly shorter than that for the masses of shorter than 1 centimeter or longer than 5 centimeters.The size cased the same difference for the blood loss.The operative time for the masses in the middle and upper part was significantly shorter than the masses in other parts,the site also did bring about sig-nificant differences in blood loss.The technique of constructing cavity,imaging and ultrasonic calpel to stop bleeding had obvious impact on operative time and blood loss.The operative time for radical thyroidectomy was longer than than for partial thyroidectomy,while 2 pa-tients had a temporary injury of recurrent laryngeal nerves after the adical thyroidectomy.The significant differences in blood loss were found.Conclusion:The learning curve of the modified Miccoli mode endoscopic thyroidectomy requires approximately 30 cases to achieve more proficiency.Advanced technology and equipment,proper choice of patients and simple way of operation can passivate the learning curve of this kind.