Hand-side matching in TOETVA: assessing feasibility and surgical outcomes through learning curve and propensity score-matched cohorts.

OBJECTIVE

To address the lack of guidance for operating the non-dominant side in TOETVA by assessing whether non-dominant-hand TOETVA on the non-dominant side (left hand-left lobe) is a feasible strategy with similar surgical outcomes compared with the conventional dominant-hand approach (right hand-right lobe).

METHODS

This is a single-center, single-surgeon retrospective cohort. Consecutive unilateral TOETVA cases (August 2016-August 2020) were included. Patients were grouped as NDH-TOETVA (left hand on the left lobe) or DH-TOETVA (right hand on the right lobe). Learning curves were segmented using cumulative sum (CUSUM) of operative time into Phase I (initial), Phase II (adaptation), and Phase III (mastery). Phase III outcomes were compared after 1:1 propensity score matching (PSM) on key covariates.

RESULTS

CUSUM identified distinct phase boundaries: DH-TOETVA Phase I cases 1-13, Phase II 14-54, Phase III ≥ 55; NDH-TOETVA Phase I 1-17, Phase II 18-37, and Phase III ≥ 38. After PSM in Phase III, 176 patients were analyzed (NDH 88 cases, DH 88 cases). Post-match baseline characteristics were balanced. There were no significant differences between NDH and DH in operative time, estimated blood loss, central neck lymph nodes retrieved/positive, length of stay, postoperative drainage, and complications (P > 0.05).

CONCLUSIONS

Hand-side matching is a feasible strategy with compared surgical outcomes in TOETVA. Findings support incorporating this strategy and bilateral-hand training into standardized practice with phase-based, objective assessment.

TRIAL REGISTRATION NUMBER: Chinese Clinical Trial Registry (UIN: ChiCTR2500097005, https://www.chictr.org.cn ), 2025.2.11.