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TOETVA: a single surgeon’s learning curve and a case report of CASTLE thyroid tumor

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Abstract

Background

Owing to the lack of visible scars, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers superior aesthetic outcomes compared to conventional thyroidectomy. Carcinoma showing thymus-like differentiation (CASTLE) represents a rare thyroid gland neoplasm. This study aimed to explore the TOETVA learning curve and present a case report of CASTLE.

Methods

A study with precise 1:1 matching was conducted to assess the procedure safety and cancer control outcomes of TOETVA in comparison to conventional surgery between May 2020 and May 2023. Cumulative sum analysis was employed to optimally fit the learning curve. Subsequently, a case report of CASTLE treated with TOETVA surgery was presented.

Results

The mean operative time was longer in the TOETVA group than in the open group. The TOETVA group had a higher incidence of skin numbness and excellent cosmetic outcomes compared to the open group. The learning curves for work area preparation, unilateral thyroid lobectomy, and the entire surgical process were 59, 28, and 50 cases, respectively. There were no differences between the learning and proficient groups, except for operative time, intraoperative blood loss, and drainage volume on the first postoperative day.

Conclusions

A comprehensive analysis of the TOETVA learning curve utilizing cumulative and analytical methods demonstrated the feasibility of TOETVA with regards to surgical integrity, safety, and oncological safety. This study’s findings suggest that a surgeon’s cumulative number of TOETVA cases exceeding 50 can reach the mastery stage. Moreover, diagnosing CASTLE is challenging and necessitates immunohistochemical detection of relatively specific markers associated with thymic epithelial tumors.

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Data availability

The data and materials used in this research article can be obtained by contacting the authors upon request. Please email 1,327,458,939@qq.com to make a request.

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Acknowledgements

The authors express their gratitude to Professor Jin-Peng Chen and Jian-Hua Shi for their guidance on this article at the Department of Thyroid and Breast Surgery, Second Affiliated Hospital of Nantong University.

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Authors and Affiliations

  1. Department of Thyroid and Breast Surgery, Nantong City No 1 People’s Hospital and Second Affiliated Hospital of Nantong University, Chongchuan District, No. 6, North Child Lane, Nantong, Jiangsu, China

    Xiaohu Jin, Zhiqi Huang & Ronghua Yuan

  2. Department of Gastrointestinal Surgery, Nantong City No 1 People’s Hospital and Second Affiliated Hospital of Nantong University, Nantong, China

    Peng Guo

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  1. Xiaohu Jin
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Contributions

Xiaohu Jin, Zhiqi Huang, and Peng Guo collected the clinical data. Xiaohu Jin wrote the main manuscript text and prepared figures and tables. Ronghua Yuan polished and supervised the writing process. All authors reviewed the manuscript.

Corresponding author

Correspondence to Ronghua Yuan.

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Ethical approval and consent to participate

All procedures involving human subjects in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki Declaration (revised in 2013). The research received the stamp of approval from the Ethics Committee of the Second Affiliated Hospital of Nantong University (NO.2023KT094), and all participating patients provided written informed consent.

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Jin, X., Huang, Z., Guo, P. et al. TOETVA: a single surgeon’s learning curve and a case report of CASTLE thyroid tumor. Langenbecks Arch Surg 408, 398 (2023). https://doi.org/10.1007/s00423-023-03140-8

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