ArticleSurgical endoscopy2026
Learning curve and functional safety in robotic thyroidectomy via bilateral axillo-breast approach: a prospective study of 537 cases.
Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimRobotic 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.
methodsA 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.
resultsAmong 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.
conclusionsRobotic 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.
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