Secondary Logo

Institutional members access full text with Ovid®

The Learning Curve for Surgeons Regarding Endoscopic Thyroidectomy via the Oral-vestibular Approach

Qu, Rui, MD*,†; Wang, Jianxue, MD*; Li, Jinyi, MD*; Dong, Zhiyong, MD*; Yang, Jingge, MD*; Liu, Daosheng, MD; Wang, Cunchuan, PhD*

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: December 2018 - Volume 28 - Issue 6 - p 380–384
doi: 10.1097/SLE.0000000000000578
Original Articles

Background: For selected patients, endoscopic thyroidectomy via the oral-vestibular approach (ETOVA) can be used to achieve a very good esthetic effect. This study aimed to assess the learning curve for ETOVA and identify improvements.

Patients and Methods: This retrospective study evaluated the outcomes of 101 patients who underwent ETOVA by surgeons A and B. The patients were classified according to whether they had undergone surgery during the primary or advanced stage of the learning curve, respectively. Proficiency with the procedure in various types of cases and the operation time, operative blood loss, hospital stay length, and postoperative complications were analyzed.

Results: In total, 56 and 45 patients were treated by surgeons A and B, respectively. For both surgeons, the operation times decreased considerably after 20 cases. Statistically significant differences with respect to stage were observed in terms of operation time (P<0.05) and drainage tube reservation (P<0.05). By contrast, significant differences were not observed between stages in terms of operative blood loss (P>0.05) or postoperative hospital stay length (P>0.05). The total postoperative complication rate was low and comparable with that of open surgery.

Conclusions: The specific learning curve identified for ETOVA suggests that surgeons with sufficient endoscopic surgery experience could achieve a stable proficiency after ∼20 cases. A standardized training program and exposure to more cases would reduce the learning curve.

*Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou

Department of Thyroid Surgery, First People’s Hospital of Zunyi City, Zunyi, China

R.Q. and J.W. contributed equally.

The authors declare no conflicts of interest.

Reprints: Cunchuan Wang, PhD, Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou 510630, China (e-mail:,

Received September 18, 2017

Accepted August 14, 2018

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.