Optimizing Robotic Thyroidectomy: Learning Curves and Functional Safety with the BABA Technique

According to an article in Surgical Endoscopy, robotic thyroidectomy via the BABA technique demonstrates measurable gains in efficiency and functional safety across a 537-case prospective series. The series documented progressive reductions in operative time and adverse-event rates as the team accumulated experience.

In a prospective series of 537 consecutive robotic BABA thyroidectomies, the team tracked operative time, recurrent laryngeal nerve (RLN) adverse events, inadvertent parathyroidectomy, parathyroid hormone (PTH) recovery, and overall adverse events. Mean operative time fell from 189.9 to 129.3 minutes (≈31% reduction). RLN adverse events declined from 16.7% to 1.6%, inadvertent parathyroidectomy decreased from 23.8% to 1.6%, and six‑month PTH improved from 3.15 to 4.14 pmol/L.

CUSUM and segmented regression delineated four practical learning phases—early, consolidation, plateau, and mastery—with breakpoints near cases 42, 152, and 352, corresponding roughly to case ranges 1-42, 43-152, 153-352, and 353-537. Operative time and event rates fell across these phases, with stabilization points around 152 and 352 cases that mark predictable gains as experience accrued.

Experience paired with targeted intraoperative refinements reduced RLN injury and inadvertent parathyroidectomy across the series. Validated refinements included continuous real‑time nerve monitoring, standardized dissection steps, meticulous hemostasis, controlled energy use near critical structures, parathyroid‑preservation strategies with intraoperative PTH testing and selective autotransplantation, and consistent camera and instrument positioning.