Skip to main content

Advertisement

Log in

Supervised surgical trainees perform thyroid surgery for Graves’ disease safely

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

There is little information about the effect of operative experience and supervision of trainees on long-term outcomes after thyroid resection for Graves’ disease (GD). The aim of this study was to compare the morbidity rate after thyroid resection performed by trainees vs consultant surgeons.

Methods

Based on a cross-sectional design analysis with a median follow-up of 96 months (range, 12–216 months), long-term outcomes for 111 patients operated on by consultants were compared with those of 42 patients operated on by supervised trainees in an academic teaching hospital between 1987 and 2002.

Results

Of the 111 patients operated on by the consultants, there were 25 (21.6%) cases of transient and 12 (10.8%) cases of permanent hypocalcemia and 10 (9.0%) cases of transient and 1 (0.9%) case of permanent recurrent laryngeal nerve (RLN) palsy. Of the 42 patients operated upon by the supervised trainees, there were 8 (21.4%) cases of transient and no permanent hypocalcemia, 3 (7.1%) cases of transient, and 1 (2.3%) case of permanent RLN palsy. Permanent complication rate of the entire group was low, and the grade of the primary surgeon made no difference in the occurrence of complications (P>0.05).

Conclusion

Supervised trainees can perform thyroid surgery for GD safely if a standardized surgical teaching program is available.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Smith E, Taylor M, Mendoza M, Barkmeier J, Lemke J, Hoffman H (1998) Spasmodic dysphonia and vocal fold paralysis: outcomes of voice problems on work-related functioning. J Voice 12(2):223–232

    Article  PubMed  CAS  Google Scholar 

  2. Thomusch O, Machens A, Sekulla C, Ukkat J, Brauckhoff M, Dralle H (2003) The impact of surgical technique on postoperative hypoparathyroidism in bilateral thyroid surgery: a multivariate analysis of 5846 consecutive patients. Surgery 133(2):180–185

    Article  PubMed  Google Scholar 

  3. Lal G, Ituarte P, Kebebew E, Siperstein A, Duh QY, Clark OH (2005) Should total thyroidectomy become the preferred procedure for surgical management of Graves’ disease? Thyroid 15(6):569–574

    Article  PubMed  Google Scholar 

  4. Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137(3):342–347

    Article  PubMed  Google Scholar 

  5. Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228(3):320–330

    Article  PubMed  CAS  Google Scholar 

  6. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, Grond S, Muhlig HP, Richter C, Voss J, Thomusch O, Lippert H, Gastinger I, Brauckhoff M, Gimm O (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136(6):1310–1322

    Article  PubMed  Google Scholar 

  7. Friedrich T, Steinert M, Keitel R, Sattler B, Schonfelder M (1998) Incidence of damage to the recurrent laryngeal nerve in surgical therapy of various thyroid gland diseases—a retrospective study. Zentralbl Chir 123(1):25–29 (in German)

    PubMed  CAS  Google Scholar 

  8. Feinstein AR (1985) Clinical epidemiology. The architecture of clinical research. Saunders, Philadelphia

    Google Scholar 

  9. Pickardt CR, Scriba PC (1991) What does the internist expect of surgeons in surgery of benign thyroid diseases?? Chirurg 62:176–181 (in German)

    Google Scholar 

  10. Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73(9):761–768

    Article  PubMed  Google Scholar 

  11. Dener C (2002) Complication rates after operations for benign thyroid disease. Acta Otolaryngol 122:679–683

    Article  PubMed  Google Scholar 

  12. Liu Q, Djuricin G, Prinz RA (1998) Total thyroidectomy for benign thyroid disease. Surgery 123:2–7

    PubMed  CAS  Google Scholar 

  13. Jatzko GR, Lisborg PH, Müller MG, Wette VM (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115:139–144

    PubMed  CAS  Google Scholar 

  14. Palit TK, Miller CC III, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90(2):161–165

    Article  PubMed  CAS  Google Scholar 

  15. Shindo ML, Sinha UK, Rice DH (1995) Safety of thyroidectomy in residency: a review of 186 consecutive cases. Laryngoscope 105:1173–1175

    Article  PubMed  CAS  Google Scholar 

  16. Shaha A, Jaffe BM (1988) Complications of thyroid surgery performed by residents. Surgery 104:1109–1114

    PubMed  CAS  Google Scholar 

  17. Reeve TS, Curtin A, Fingleton L, Kennedy P, Mackie W, Porter T, Simons D, Townend D, Delbridge L (1994) Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units? Making the case for surgical training. Arch Surg 129:834–836

    PubMed  CAS  Google Scholar 

  18. Burge MR, Zeise TM, Johnsen MW, Conway MJ, Qualls CR (1998) Risks of complication following thyroidectomy. J Gen Intern Med 13(1):24–31

    Article  PubMed  CAS  Google Scholar 

  19. Lamade W, Renz K, Willeke F, Klar E, Herfarth C (1999) Effect of training on the incidence of nerve damage in thyroid surgery. Br J Surg 86(3):388–391

    Article  PubMed  CAS  Google Scholar 

  20. Nies C, Sitter H, Zielke A, Bandorski T, Menze J, Ehlenz K, Rothmund M (1994) Parathyroid function following ligation of the inferior thyroid artery during bilateral subtotal thyroidectomy. Br J Surg 81(12):1757–1759

    PubMed  CAS  Google Scholar 

  21. Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V (1992) Hypocalcemia after thyroidectomy. Arch Surg 127(7):854–888

    PubMed  CAS  Google Scholar 

  22. Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC (2005) Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J 52(2):199–205

    Article  PubMed  Google Scholar 

  23. Ku CF, Lo CY, Chan WF, Kung AW, Lam KS (2005) Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. ANZ J Surg 75(7):528–531

    Article  PubMed  Google Scholar 

  24. Mantke R, Pross M, Klose S, Lehnert H, Lippert H (2003) The harmonic scalpel in conventional thyroid surgery. Possibilities and advantages. Chirurg 74(8):739–742 (in German)

    Article  PubMed  CAS  Google Scholar 

  25. McHenry CR, Speroff T, Wentworth D, Murphy T (1994) Risk factors for postthyroidectomy hypocalcemia. Surgery 16(4):641–648

    Google Scholar 

  26. Wagner HE, Seiler CA (1994) Recurrent laryngeal nerve palsy after thyroid surgery. Br J Surg 81:226–229

    PubMed  CAS  Google Scholar 

  27. Witte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M, Roher HD (2000) Surgery for Graves’ disease: total versus subtotal thyroidectomy—results of a prospective randomized trial. World J Surg 24(11):1303–1311

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Iyad Hassan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hassan, I., Koller, M., Kluge, C. et al. Supervised surgical trainees perform thyroid surgery for Graves’ disease safely. Langenbecks Arch Surg 391, 597–602 (2006). https://doi.org/10.1007/s00423-006-0077-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-006-0077-x

Keywords

Navigation