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Aim <p>Robotic thyroidectomy via the bilateral axillo-breast approach (BABA) provides excellent cosmetic outcomes, but its adoption is limited by a steep learning curve and concerns about functional safety. This study aimed to define the learning curve trajectory and evaluate functional safety outcomes—with the primary endpoint of intraoperative RLN adverse events and secondary endpoints of inadvertent parathyroidectomy and PTH recovery.</p> Methods <p>A prospective cohort study was conducted at a high-volume endocrine surgery center from March 2018 to March 2024. A total of 537 consecutive patients with differentiated thyroid carcinoma underwent robotic BABA thyroidectomy with central neck dissection. Intraoperative refinements included real-time recurrent laryngeal nerve (RLN) monitoring, intraoperative parathyroid-hormone (PTH) testing, and nanocarbon lymph node mapping. Learning phases were defined by cumulative sum analysis. Primary outcomes were intraoperative RLN adverse events and inadvertent parathyroidectomy; secondary outcomes included operative time, lymph node yield, PTH recovery, complication rates, and tracheal injury.</p> Results <p>Among 537 patients (401 women, 74.7%; median age 43&#xa0;years), operative time decreased from 189.9 to 129.3&#xa0;min (<i>P</i> &lt; 0.001), with plateaus at 152 and 352 cases. RLN adverse events declined from 16.7% (95% CI 7.9–30.2%) to 1.6% (95% CI 0.3–4.8%), and inadvertent parathyroidectomy decreased from 23.8% (95% CI 12.0–39.5%) to 1.6% (95% CI 0.3–4.8%). Six-month PTH levels improved from 3.15 to 4.14&#xa0;pmol/L, and lymph node yield increased from 9.9 to 13.3 (<i>P</i> = 0.019). Three patients (0.6%) developed tracheal fistula.</p> Conclusions <p>Robotic BABA thyroidectomy demonstrates a structured learning curve in which functional safety improves with surgical experience and intraoperative standardization. These data-driven milestones may inform structured training and credentialing frameworks for robotic thyroid surgery.</p>

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Learning curve and functional safety in robotic thyroidectomy via bilateral axillo-breast approach: a prospective study of 537 cases

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月28日

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  • Si-Si Wang,
  • Zi-han Tang,
  • Wen-Yu Huang,
  • Xuan Lin,
  • Shao-Feng He,
  • Meng-Ting Lin,
  • Nan Xu,
  • Bin Han,
  • ZhiHong Wang,
  • Sean Hua,
  • Amr H. Abdelhamid Ahmed,
  • Gregory W. Randolph,
  • Wen-Xin Zhao,
  • Bo Wang

摘要

Aim

Robotic thyroidectomy via the bilateral axillo-breast approach (BABA) provides excellent cosmetic outcomes, but its adoption is limited by a steep learning curve and concerns about functional safety. This study aimed to define the learning curve trajectory and evaluate functional safety outcomes—with the primary endpoint of intraoperative RLN adverse events and secondary endpoints of inadvertent parathyroidectomy and PTH recovery.

Methods

A prospective cohort study was conducted at a high-volume endocrine surgery center from March 2018 to March 2024. A total of 537 consecutive patients with differentiated thyroid carcinoma underwent robotic BABA thyroidectomy with central neck dissection. Intraoperative refinements included real-time recurrent laryngeal nerve (RLN) monitoring, intraoperative parathyroid-hormone (PTH) testing, and nanocarbon lymph node mapping. Learning phases were defined by cumulative sum analysis. Primary outcomes were intraoperative RLN adverse events and inadvertent parathyroidectomy; secondary outcomes included operative time, lymph node yield, PTH recovery, complication rates, and tracheal injury.

Results

Among 537 patients (401 women, 74.7%; median age 43 years), operative time decreased from 189.9 to 129.3 min (P < 0.001), with plateaus at 152 and 352 cases. RLN adverse events declined from 16.7% (95% CI 7.9–30.2%) to 1.6% (95% CI 0.3–4.8%), and inadvertent parathyroidectomy decreased from 23.8% (95% CI 12.0–39.5%) to 1.6% (95% CI 0.3–4.8%). Six-month PTH levels improved from 3.15 to 4.14 pmol/L, and lymph node yield increased from 9.9 to 13.3 (P = 0.019). Three patients (0.6%) developed tracheal fistula.

Conclusions

Robotic BABA thyroidectomy demonstrates a structured learning curve in which functional safety improves with surgical experience and intraoperative standardization. These data-driven milestones may inform structured training and credentialing frameworks for robotic thyroid surgery.