Study On The Clinical Effect And Learning Curve Of Endoscopic Thyroid Surgery

Part one: Application of modified video-assisted lateral neck dissection in papillary thyroid carcinomaObjective: To explore the safety,feasibility,cosmetic result and long-term quality of life,by comparing the clinical applications on lateral neck dissection in papillary thyroid carcinoma between modified video-assisted and traditional open way.Methods: A retrospective analysis was performed to collect all cases,who underwent lateral neck dissection by modified video-assisted or traditional open way,in department of breast and thyroid surgery,Hebei General Hospital,from July 2014 to July 2015,which were divided into two groups: endoscopic group and traditional group.The gender,age,body mass index(BMI),intraoperative bleeding volume,operating time,number of lymph node dissection,surgical complications,and postoperative quality of life of the two groups were collected through case collection and telephone follow-up.SPSS 23.0 statistical software was used to analyze the results,P<0.05 was considered statistically significant difference.Correlations and differences were analyzed between endoscopic group and traditional group.Results: According to the criteria of inclusion and exclusion,seven patients were included in the endoscopy group and the traditional group respectively,among them,8 sides of cervical lymph nodes were cleaned in the endoscopy group,9 sides of cervical lymph nodes were cleaned in the traditional group.There was no significant difference between the two groups in gender,age,BMI,operation time,intraoperative bleeding volume,number of unilateral lymph nodes,postoperative hospital stay,and operation cost(P > 0.05).There were significant differences in postoperative drainage volume,postoperative drainage time,postoperative quality of life and scar satisfaction between the two groups(P<0.05).Part two: Learning curve of endoscopic thyroid surgery via breast approachObjective: To explore the learning curve of endoscopic thyroid surgery via breast approach,analyze the risk factors influencing the clinical effect of operation and share the growing experience who had never performed any endoscopic thyroid surgery(EST)before.Methods: A retrospective analysis was made on the base of 54 cases of endoscopic thyroid surgery via breast approach,which were performed by the same group of surgeons in department of breast and thyroid surgery,Hebei General Hospital,from July 2014 to May 2019.General clinical data were collected,including sex,age,BMI,paraffin pathological results,operation name,whether Hashimoto's thyroiditis was combined or not,and operation related data included operation time,intraoperative bleeding volume,postoperative drainage time,postoperative total drainage volume,operation related complications,and operation cost.All of the cases were divided into five groups: A,B,C,D and E according to the surgical sequence.Learning curve was analyzed by using moving average method.According to the turning point of learning curve,all cases were divided into learning stage(LS)group and mastering stage(MS)group.In MS group,according to the relationship with the average operation time,they were divided into operation time shortening group and operation time prolonging group.The factors affecting operation time in MS group were analyzed by odds ratio(OR)and 95% confidence intervals(95%CI).Results:1.Learning curve of endoscopic thyroid surgery via breast approachAll of the 55 cases underwent the surgery successfully by the same group of surgeons.There were no statistical differences among the five groups in age,gender,BMI,pathological results,surgical methods,Hashimoto's thyroiditis or not(P>0.05).There were no significant differences in bleeding volume,drainage time,total drainage volume and operation cost among the groups(P>0.05).The operation time of group A was significantly different from that of group B,C,D and E(P<0.05),but there were no difference among groups of B,C,D and E(P>0.05).The learning curve of endoscopic thyroid surgery via breast approach was 10 cases,and the surgeons entered MS after the 10 th operation.There were 6 patients with operation related complications,including open conversion,skin burn,subcutaneous hydrops,hypocalcemia,3 in group A,1 in group C,1 in Group D,1 in Group E.All patients had no complications such as hoarseness,cough and dyspnea.2.Factors influencing the operation time of endoscopic thyroid surgery via breast approachThere were significant differences between the two groups in BMI,single or double side of operation,whether combined with Hashimoto's thyroiditis(P<0.05),of which double side of operation and BMI?24.0 were the risk factors of prolonging operation time(OR=26.639,95%CI:2.410-294.426;OR=42.369,95%CI:4.013-447.357).There was no statistical difference between the two groups in age,gender,tumor benign or malignant,(P>0.05).There was no statistical difference between the two groups in the amount of intraoperative bleeding,postoperative drainage time,postoperative drainage flow,surgical costs and other related indicators(P>0.05).Conclusions:1.The modified video-assisted lateral neck dissection is safe and feasible.In the long-term follow-up,the modified video-assisted lateral neck dissection has better quality of life and aesthetic effect.2.The learning curve of endoscopic thyroid surgery via breast approach is obvious.For the chief physician who has the experience of conventional open thyroid surgery,10 patients have passed the platform stage and entered the mastering stage.If the Application of modified video-assisted is also part of the learning process of endoscopic technology,the learning curve is about 21 cases.3.Bilateral operation and overweight/obesity are the risk factors for prolonging the operation time.