{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:51:56Z","timestamp":1753890716744,"version":"3.41.2"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is distinguished by its ability to leave no visible scars on the body\u2019s surface. Currently, there is still a lack of single-center large sample size analysis on the learning curve of TOETVA, especially for the treatment of thyroid cancer. This study aims to fill this void by presenting a comprehensive analysis of the learning curve and assessing the procedure\u2019s feasibility in managing thyroid cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between June 2020 and June 2023, a retrospective analysis was conducted on 195 patients who had undergone the transoral endoscopic thyroidectomy vestibular approach (TOETVA) at the First Affiliated Hospital of Zhengzhou University. We employed the cumulative sum method (CUSUM) to delineate the learning curve of TOETVA. Additionally, clinical parameters across different stages of the learning process were meticulously compared and analyzed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients successfully completed endoscopic surgery without conversion to open surgery. Utilizing the CUSUM algorithm, two distinct learning phases were delineated: the exploration phase, comprising 58 cases, and the maturation phase, encompassing 137 cases. Analysis revealed that the maturation phase demonstrated significantly reduced operative times (189.7 \u00b1 237.27 <jats:italic>vs<\/jats:italic>. 138.15 \u00b1 26.62 minutes, p&amp;lt;0.001), decreased blood loss (15.49 \u00b1 15.05 <jats:italic>vs<\/jats:italic>. 9.67 \u00b1 4.12 ml, p=0.005), and a lower incidence of complications (7 <jats:italic>vs<\/jats:italic>. 4, p=0.028) when compared to the exploration phase. Additionally, in the maturation phase, we achieved successful surgical outcomes in a subset of obese patients and those with nodular goiter.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>TOETVA has been demonstrated to be safe and feasible, with the capability to effectively address complex cases once the learning curve has been surmounted.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fendo.2024.1498797","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T07:04:45Z","timestamp":1736147085000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transoral endoscopic thyroid lobectomy and ipsilateral central neck lymph node dissection vestibular approach: analysis of the learning curve and clinical outcomes evaluation"],"prefix":"10.3389","volume":"15","author":[{"given":"Yuhang","family":"Deng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiaojiao","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mei","family":"Tao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haixin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruoxin","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoming","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiubo","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,6]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.8759","article-title":"Global burden of thyroid cancer from 1990 to 2017","volume":"3","author":"Deng","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B2","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jncc.2024.01.006","article-title":"Cancer incidence and mortality in Chin","volume":"4","author":"Han","year":"2024","journal-title":"J Natl Cancer Cent"},{"key":"B3","article-title":"Expert consensus of endoscopic thyroid surgery via oral vestibular approach edition)","volume":"38","author":"Wang","year":"2018","journal-title":"Chin J Pract Surg"},{"key":"B4","doi-asserted-by":"crossref","DOI":"10.1007\/s00405-011-1613-z","article-title":"Scars and satisfaction: do smaller scars improve patient-reported outcome","volume":"269","author":"Toll","year":"2012","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.5021\/ad.2014.26.6.693","article-title":"Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients","volume":"26","author":"Choi","year":"2014","journal-title":"Ann Dermatol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/lary.v127.5","article-title":"Midcervical scar satisfaction in thyroidectomy patients","author":"Best","year":"2017","journal-title":"Laryngoscope: A Med J Clin Res Contributions Otolaryngology Head Neck Med Surgery Facial Plast Reconstructive Surgery."},{"key":"B7","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1002\/bjs.1800830656","article-title":"Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism","volume":"83","author":"Gagner","year":"1996","journal-title":"Br J Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-009-0820-9","article-title":"Video. 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A new transoral technique of endoscopic thyroidectomy with gasless premandible approach","volume":"27","author":"Nakajo","year":"2013","journal-title":"Surg Endosc"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2018.12.005","article-title":"Remote-access thyroidectomy: A multi-institutional north american experience with transaxillary, robotic facelift, and transoral endoscopic vestibular approaches","volume":"228","author":"Russell","year":"2019","journal-title":"J Am Coll Surg"},{"key":"B22","first-page":"843","article-title":"A comparative study of endoscopic assisted lateral neck dissection and open lateral neck dissection in the treatment of cervical lymph node metastasis of papillary thyroid carcinoma","author":"Zhang","year":"2020","journal-title":"Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 34(9)"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1097\/JS9.0000000000000651","article-title":"Challenging routine: technical difficulties and solutions of endoscopic thyroidectomy via a combined transoral and breast approach - a case-series and learning curve","volume":"109","author":"Zhou","year":"2023","journal-title":"Int J Surg"},{"key":"B24","article-title":"Current status and prospects of transoral endoscopic thyroid surgery","volume":"32","author":"Wang","year":"2023","journal-title":"Chin J Gen Surg"},{"key":"B25","article-title":"Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma: a report of 10 cases","volume":"56","author":"Wu","year":"2021","journal-title":"Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2024.1498797\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T07:04:48Z","timestamp":1736147088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2024.1498797\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,6]]},"references-count":25,"alternative-id":["10.3389\/fendo.2024.1498797"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2024.1498797","relation":{},"ISSN":["1664-2392"],"issn-type":[{"type":"electronic","value":"1664-2392"}],"subject":[],"published":{"date-parts":[[2025,1,6]]},"article-number":"1498797"}}