Robotic thyroidectomy via bilateral axillo-breast approach: Experience and learning curve through initial 220 cases.

OBJECTIVE: This study is aim to summarize the experience of robotic thyroidectomy via bilateral axillo-breast approach of our center and also to find out the learning curve of this technique. METHODS: In total 220 initial patients who have undergone robotic thyroidectomy via bilateral axillo-breast approach from May 2015 to September 2017 were involved in this study. The data of operation time, clinical characteristics, surgical outcomes and oncological outcomes were collected. The moving average method is use to explore the learning curve. RESULTS: All patients had undergone robotic thyroidectomy successfully without conversion to other surgical approaches. The mean age of the enrolled subjects was 34.4 ± 7.8 years old, while the sex ratio (male/female) was 38/182. There were 50 benign tumor cases and 170 malignant tumor cases. The mean total operation time was 105.3 ± 37.6 min. Lymph node metastasis was observed in 61 (35.9%) patients. The mean retrieved lymph node count was 5.1 ± 3.8 while the mean metastatic lymph node count was 0.7 ± 1.5. The operation time decreased significantly after about 30-35 cases and formed the plateau. After 80 cases, the operation time significantly decreased again. CONCLUSION: For skilled endocrine surgeons, robotic thyroidectomy has proved to be safe and feasible, which could be applied extensively in patients strictly selected in high-volume centers, with a relatively short learning curve of about 30-35 cases. While the surgeons getting more experienced, this technique would be more efficient.

Left atrial function in healthy Chinese population by cardiac magnetic resonance-feature tracking imaging: A quantitative study / 第二军医大学学报

ObjectiveTo quantitatively evaluate the left atrial function in healthy Chinese population by cardiac magnetic resonance-feature tracking (CMR-FT). MethodsHealthy individuals with normal magnetic resonance examination results were enrolled according to the inclusion criteria. Cardiac long- and short-axis images and cine were obtained using semi-Fourier single-shot technique and balanced steady-state free precession sequence. The left atrial function parameters, including left atrial volume, ejection fraction, strain and strain rate, were measured by 2 independent observers. Two independent sample t test was used to compare the parameters between males and females. One-way analysis of variance was performed to compare the parameters among different age groups. ResultsA total of 63 volunteers were included in this study. Of 63 volunteers, 34 were males and 29 females; and 19 volunteers were aged≤29 years, 23 were aged 30-44 years and 21 were aged≥45 years. The anteroposterior diameter of left atrium was (26.1±4.5) mm, and the transverse diameter was (54.8±5.9) mm. The total ejection fraction of left atrium was (63.5±6.9)%, total strain was (45.9±11.7)%, and total strain rate was (1.5±0.5) s-1. The passive ejection fraction of left atrium was (24.6±9.1)%, passive strain was (22.2±8.1)%, and passive strain rate was (-0.8±0.3) s-1. The active ejection fraction of left atrium was (51.3±8.9)%, active strain was (23.7±9.2)%, and active strain rate was (-1.3±0.5) s-1. There were significant differences in the body surface area, the left atrial diameters, maximal volume and pre-active contraction volume between the males and the females (all P0.05). There were significant differences in the left atrial conduit function among the different age groups (all P0.6, and the Bland-Altman analysis showed better consistency between the two observers. ConclusionCMR-FT can be used to obtain parameters related to left atrial function in healthy Chinese population due to its high repeatability.