{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T15:31:11Z","timestamp":1787931071494,"version":"build-2784847793"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2019,3,22]],"date-time":"2019-03-22T00:00:00Z","timestamp":1553212800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","award":["2017R1C1B5076977"],"award-info":[{"award-number":["2017R1C1B5076977"]}],"id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>With the increased utilization of robot thyroidectomy in recent years, surgical proficiency is the paramount consideration. However, there is no single perfect or ideal method for measuring surgical proficiency. In this study, we evaluated the learning curve of robotic thyroidectomy using various parameters. A total of 172 robotic total thyroidectomies were performed by a single surgeon between March 2014 and February 2018. Cumulative summation analysis revealed that it took 50 cases for the surgeon to significantly improve the operation time. Mean operation time was significantly shorter in the group that included the 51st to the 172nd case, than in the group that included only the first 50 cases (132.8 \u00b1 27.7 min vs. 166.9 \u00b1 29.5 min; p &lt; 0.001). On the other hand, the surgeon was competent after the 75th case when postoperative transient hypoparathyroidism was used as the outcome measure. The incidence of hypoparathyroidism gradually decreased from 52.0%, for the first 75 cases, to 40.2% after the 76th case. These results indicated that the criteria used to assess proficiency greatly influenced the interpretation of the learning curve. Incorporation of the operation time, complications, and oncologic outcomes should be considered in learning curve assessment.<\/jats:p>","DOI":"10.3390\/jcm8030402","type":"journal-article","created":{"date-parts":[[2019,3,25]],"date-time":"2019-03-25T06:56:52Z","timestamp":1553497012000},"page":"402","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Quantitative Assessment of the Learning Curve for Robotic Thyroid Surgery"],"prefix":"10.3390","volume":"8","author":[{"given":"HyunGoo","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4979-8749","authenticated-orcid":false,"given":"Hyungju","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woosung","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-In","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nam Sun","family":"Paik","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ewha Womans University Medical Center, 1071 Anyangcheon-ro, Yangcheon-Gu, Seoul 07985, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"250","DOI":"10.21037\/gs.2017.04.05","article-title":"Bilateral axillo-breast approach robotic thyroidectomy: Review of evidences","volume":"6","author":"Liu","year":"2017","journal-title":"Gland Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.1097\/SLE.0b013e3181a4ccae","article-title":"Endoscopic thyroidectomy with the da Vinci robot system using the bilateral axillary breast approach (BABA) technique: Our initial experience","volume":"19","author":"Lee","year":"2009","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1097\/SLE.0000000000000187","article-title":"In-Depth Survey of Scarring and Distress in Patients Undergoing Bilateral Axillo-Breast Approach Robotic Thyroidectomy or Conventional Open Thyroidectomy","volume":"25","author":"Koo","year":"2015","journal-title":"Surg. Laparosc. Endosc. Percutan. Tech."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1016\/j.surg.2011.09.015","article-title":"Surgical completeness of bilateral axillo-breast approach robotic thyroidectomy: Comparison with conventional open thyroidectomy after propensity score matching","volume":"150","author":"Lee","year":"2011","journal-title":"Surgery"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1007\/s00268-016-3403-7","article-title":"Comparison of Bilateral Axillo-Breast Approach Robotic Thyroidectomy with Open Thyroidectomy for Graves\u2019 Disease","volume":"40","author":"Kwon","year":"2016","journal-title":"World J. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1007\/s00464-018-6473-9","article-title":"A systematic review of the learning curve in robotic surgery: Range and heterogeneity","volume":"33","author":"Kassite","year":"2018","journal-title":"Surg. Endosc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1002\/bjs.9642","article-title":"Systematic review of methodological quality of individual performance measurement in surgery","volume":"101","author":"Maruthappu","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1245\/s10434-010-1220-z","article-title":"The learning curve for robotic thyroidectomy: A multicenter study","volume":"18","author":"Lee","year":"2011","journal-title":"Ann. Surg. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1002\/jso.23793","article-title":"A single surgeon\u2019s experience and surgical outcomes of 300 robotic thyroid surgeries using a bilateral axillo-breast approach","volume":"111","author":"Kim","year":"2015","journal-title":"J. Surg. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1177\/0194599812461597","article-title":"Commentary: Is robotic thyroid surgery worth the learning curve?","volume":"147","author":"Gross","year":"2012","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"4583","DOI":"10.1007\/s00464-017-5520-2","article-title":"An appraisal of the learning curve in robotic general surgery","volume":"31","author":"Pernar","year":"2017","journal-title":"Surg. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1576","DOI":"10.1007\/s00268-013-2027-4","article-title":"Bilateral axillo-breast approach robotic thyroidectomy for Graves\u2019 disease: An initial experience in a single institute","volume":"37","author":"Kwon","year":"2013","journal-title":"World J. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1007\/s00464-010-1281-x","article-title":"Learning curve for robotic-assisted laparoscopic colorectal surgery","volume":"25","author":"Bokhari","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Yu, J., Rao, S., Lin, Z., Pan, Z., Zheng, X., and Wang, Z. (2018). The learning curve of endoscopic thyroid surgery for papillary thyroid microcarcinoma: CUSUM analysis of a single surgeon\u2019s experience. Surg. Endosc.","DOI":"10.1007\/s00464-018-6410-y"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1002\/bjs.6056","article-title":"Quantitative and individualized assessment of the learning curve using LC-CUSUM","volume":"95","author":"Biau","year":"2008","journal-title":"Br. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.ijom.2017.10.005","article-title":"Quantitative assessment of the learning curve for cleft lip repair using LC-CUSUM","volume":"47","author":"Segna","year":"2018","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1002\/sim.3947","article-title":"A method for monitoring a process from an out of control to an in control state: Application to the learning curve","volume":"29","author":"Biau","year":"2010","journal-title":"Stat. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00268-017-4209-y","article-title":"Yonsei Experience of 5000 Gasless Transaxillary Robotic Thyroidectomies","volume":"42","author":"Kim","year":"2018","journal-title":"World J. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2955","DOI":"10.1007\/s00464-013-2863-1","article-title":"Robotic thyroidectomy by bilateral axillo-breast approach: Review of 1,026 cases and surgical completeness","volume":"27","author":"Lee","year":"2013","journal-title":"Surg. Endosc."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"3405","DOI":"10.1001\/jama.1987.03400230065033","article-title":"Evaluation of physical examination skills. Reliability of faculty observers and patient instructors","volume":"258","author":"Elliot","year":"1987","journal-title":"JAMA"},{"key":"ref_21","first-page":"1500","article-title":"Cusum as an aid to early assessment of the surgical trainee","volume":"82","author":"Mcdonald","year":"1995","journal-title":"Br. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1136\/bmjqs-2016-005526","article-title":"Comparison of control charts for monitoring clinical performance using binary data","volume":"26","author":"Neuburger","year":"2017","journal-title":"BMJ Qual. Saf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1136\/qshc.2006.020776","article-title":"Quality control of surgical and interventional procedures: A review of the CUSUM","volume":"16","author":"Biau","year":"2007","journal-title":"Qual. Saf. Health Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1002\/bjs.9384","article-title":"Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia","volume":"101","author":"Edafe","year":"2014","journal-title":"Br. J. Surg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1210\/jc.2012-1170","article-title":"Secretory capacity of the parathyroid glands after total thyroidectomy in normocalcemic subjects","volume":"97","author":"Anastasiou","year":"2012","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1089\/thy.2017.0309","article-title":"American Thyroid Association Statement on Postoperative Hypoparathyroidism: Diagnosis, Prevention, and Management in Adults","volume":"28","author":"Orloff","year":"2018","journal-title":"Thyroid"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3844","DOI":"10.1245\/s10434-014-3846-8","article-title":"Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons","volume":"21","author":"Hauch","year":"2014","journal-title":"Ann. Surg. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1089\/thy.2015.0020","article-title":"2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer","volume":"26","author":"Haugen","year":"2016","journal-title":"Thyroid"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.1007\/s00464-015-4611-1","article-title":"Robotic single-site adrenalectomy","volume":"30","author":"Lee","year":"2016","journal-title":"Surg. Endosc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1111\/iju.12602","article-title":"Anatomical dimensions using preoperative magnetic resonance imaging: Impact on the learning curve of robot-assisted laparoscopic prostatectomy","volume":"22","author":"Yao","year":"2015","journal-title":"Int. J. Urol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s11701-008-0074-x","article-title":"The role of surgical simulation and the learning curve in robot-assisted surgery","volume":"2","author":"Bareeq","year":"2008","journal-title":"J. Robot. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/3\/402\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:40:06Z","timestamp":1760186406000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/3\/402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,22]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2019,3]]}},"alternative-id":["jcm8030402"],"URL":"https:\/\/doi.org\/10.3390\/jcm8030402","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,22]]}}}