Comparison of short-term outcomes between gasless trans-subclavian endoscopic thyroidectomy and open thyroidectomy during different learning curve stages
ZHAI Kaikai
WANG Haiyi
WANG Zheng
KUANG Jie
TIAN Yuanguang
WU Honghong
Abstract：Objective To evaluate and compare the short-term clinical outcomes of gasless trans-subclavian endo-scopic thyroidectomy performed during the growth and mature phases of the learning curve with those of conventional open thyroidectomy.Methods A retrospective analysis was conducted on 126 patients who underwent thyroidectomy,includ-ing 60 cases of subclavian gasless endoscopic thyroidectomy(observation group)and 66 cases of open thyroidectomy(con-trol group).The learning curve was constructed using cumulative sum(CUSUM)analysis,and the growth and mature phases were identified.Surgical variables(total operative time,specimen extraction time,postoperative drainage,intraop-erative blood loss,parathyroid autotransplantation rate)and postoperative outcomes(length of stay,hospital cost,1-year recurrence,complications including hypocalcaemia,hypoparathyroidism,transient vocal cord palsy and persistent dyspho-nia)were compared between the two groups across both phases.Results The best-fitting equation for the surgical learn-ing curve was CUSUMn=-1.18n2+757+41.59n+185-3n3(R²=0.952,P<0.05),demonstrating a strong fit.During the learning phase,the observation group performed 20 cases of gasless trans-subclavian endoscopic thyroid surgery,while the control group conducted 24 cases of open thyroid surgery in the same timeframe.In the proficient phase,the observa-tion group completed 40 cases,and the control group completed 42 cases.In the learning phase,compared with the con-trol group,the observation group had longer operation time and longer thyroid specimen removal time,less intraoperative blood loss,higher postoperative drainage volumes,and a higher rate of parathyroid autotransplantation(all P<0.05).In the mature phase,the observation group experienced shorter postoperative hospital stay than the control group(P<0.01).There was no statistically significant difference in the rate of postoperative complications between the two groups during the learning phase(all P>0.05).However,in the mature phase,the observation group had a lower incidence of transient hy-pocalcemia than the control group(P<0.05).Conclusion Over the transition from the growth phase to the mature phase of the learning curve,subclavian gasless endoscopic thyroidectomy confers advantages of reduced intraoperative bleeding,shorter hospitalization and lower morbidity(especially transient hypocalcaemia)in comparison with the open surgery.
Keywords：subclavian approachendoscopic thyroid surgerythyroidectomysurgical learning curve
Publication Date：2025-12-25
Online Publishing Date：2026-01-12(First online date of this platform, not the publication date of the document)
Pages：6( 70-75 )