To investigate the learning curve of endoscopic thyroidectomy by complete areola approach, explore the key steps that affect the proficiency of surgery, and guide the way of training.

Retrospective analysis of 95 patients who underwent unilateral endoscopic thyroidectomy by complete areola approach for papillary thyroid carcinoma at the initial stage of this technique, and the whole operation was recorded. The ten-step method of endoscopic thyroidectomy by complete areola approach was divided into incision positioning, puncture and cavity construction, searching for recurrent laryngeal nerve, throat entry dissection, protection of the superior laryngeal nerve branch, parathyroid preservation, neck central area dissection, specimen removal, parathyroid autotransplantation, suture and drainage. The total operation time is recorded, and it is further divided into six time periods according to the overlapping of operation steps.

The total operation time fitting curve decreased significantly in the first 20 cases, and the curve tended to be stable after 20 cases. The participants were divided into 5 groups according to the operation date(n=20, 15 cases in group 5). The total operation time of group 1 (121.25 ± 24.32) min was significantly longer than other groups (P<0.05); The time of the first steps decreased between group 1 and 2 (P<0.05), and there was no decrease between the adjacent groups after group 2 (P> 0.05); The time of the last seven steps has no decrease between the adjacent two groups (P>0.05). There were no differences in complications such as hypocalcemia and recurrent laryngeal nerve injury among the groups (P>0.05).

A well-trained thyroid open surgery and laparoscopic surgery surgeon can significantly reduce the total operation time and after 20 cases by using the ten-steps method. The key steps are the first three steps of the ten-step method, including incision positioning, puncture and cavity construction and searching for recurrent laryngeal nerve.