Skip to main content
Top
Published in: Langenbeck's Archives of Surgery 6/2006

01-11-2006 | Original Article

Supervised surgical trainees perform thyroid surgery for Graves’ disease safely

Authors: Iyad Hassan, Michael Koller, Conrad Kluge, Sebastian Hoffmann, Andreas Zielke, Matthias Rothmund

Published in: Langenbeck's Archives of Surgery | Issue 6/2006

Login to get access

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.
Literature
1.
go back to reference 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):223–232PubMedCrossRef 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):223–232PubMedCrossRef
2.
go back to reference 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):180–185PubMedCrossRef 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):180–185PubMedCrossRef
3.
go back to reference 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):569–574PubMedCrossRef 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):569–574PubMedCrossRef
4.
go back to reference 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):342–347PubMedCrossRef 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):342–347PubMedCrossRef
5.
go back to reference 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):320–330PubMedCrossRef 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):320–330PubMedCrossRef
6.
go back to reference 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):1310–1322PubMedCrossRef 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):1310–1322PubMedCrossRef
7.
go back to reference 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 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
8.
go back to reference Feinstein AR (1985) Clinical epidemiology. The architecture of clinical research. Saunders, Philadelphia Feinstein AR (1985) Clinical epidemiology. The architecture of clinical research. Saunders, Philadelphia
9.
go back to reference Pickardt CR, Scriba PC (1991) What does the internist expect of surgeons in surgery of benign thyroid diseases?? Chirurg 62:176–181 (in German) Pickardt CR, Scriba PC (1991) What does the internist expect of surgeons in surgery of benign thyroid diseases?? Chirurg 62:176–181 (in German)
10.
go back to reference Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73(9):761–768PubMedCrossRef Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73(9):761–768PubMedCrossRef
11.
go back to reference Dener C (2002) Complication rates after operations for benign thyroid disease. Acta Otolaryngol 122:679–683PubMedCrossRef Dener C (2002) Complication rates after operations for benign thyroid disease. Acta Otolaryngol 122:679–683PubMedCrossRef
12.
go back to reference Liu Q, Djuricin G, Prinz RA (1998) Total thyroidectomy for benign thyroid disease. Surgery 123:2–7PubMed Liu Q, Djuricin G, Prinz RA (1998) Total thyroidectomy for benign thyroid disease. Surgery 123:2–7PubMed
13.
go back to reference Jatzko GR, Lisborg PH, Müller MG, Wette VM (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115:139–144PubMed Jatzko GR, Lisborg PH, Müller MG, Wette VM (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115:139–144PubMed
14.
go back to reference Palit TK, Miller CC III, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90(2):161–165PubMedCrossRef Palit TK, Miller CC III, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90(2):161–165PubMedCrossRef
15.
go back to reference Shindo ML, Sinha UK, Rice DH (1995) Safety of thyroidectomy in residency: a review of 186 consecutive cases. Laryngoscope 105:1173–1175PubMedCrossRef Shindo ML, Sinha UK, Rice DH (1995) Safety of thyroidectomy in residency: a review of 186 consecutive cases. Laryngoscope 105:1173–1175PubMedCrossRef
16.
go back to reference Shaha A, Jaffe BM (1988) Complications of thyroid surgery performed by residents. Surgery 104:1109–1114PubMed Shaha A, Jaffe BM (1988) Complications of thyroid surgery performed by residents. Surgery 104:1109–1114PubMed
17.
go back to reference 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 129:834–836PubMed 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 129:834–836PubMed
18.
go back to reference Burge MR, Zeise TM, Johnsen MW, Conway MJ, Qualls CR (1998) Risks of complication following thyroidectomy. J Gen Intern Med 13(1):24–31PubMedCrossRef Burge MR, Zeise TM, Johnsen MW, Conway MJ, Qualls CR (1998) Risks of complication following thyroidectomy. J Gen Intern Med 13(1):24–31PubMedCrossRef
19.
go back to reference 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):388–391PubMedCrossRef 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):388–391PubMedCrossRef
20.
go back to reference 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):1757–1759PubMed 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):1757–1759PubMed
21.
go back to reference Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V (1992) Hypocalcemia after thyroidectomy. Arch Surg 127(7):854–888PubMed Demeester-Mirkine N, Hooghe L, Van Geertruyden J, De Maertelaer V (1992) Hypocalcemia after thyroidectomy. Arch Surg 127(7):854–888PubMed
22.
go back to reference 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):199–205PubMedCrossRef 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):199–205PubMedCrossRef
23.
go back to reference 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):528–531PubMedCrossRef 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):528–531PubMedCrossRef
24.
go back to reference 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)PubMedCrossRef 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)PubMedCrossRef
25.
go back to reference McHenry CR, Speroff T, Wentworth D, Murphy T (1994) Risk factors for postthyroidectomy hypocalcemia. Surgery 16(4):641–648 McHenry CR, Speroff T, Wentworth D, Murphy T (1994) Risk factors for postthyroidectomy hypocalcemia. Surgery 16(4):641–648
26.
go back to reference Wagner HE, Seiler CA (1994) Recurrent laryngeal nerve palsy after thyroid surgery. Br J Surg 81:226–229PubMed Wagner HE, Seiler CA (1994) Recurrent laryngeal nerve palsy after thyroid surgery. Br J Surg 81:226–229PubMed
27.
go back to reference 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):1303–1311PubMedCrossRef 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):1303–1311PubMedCrossRef
Metadata
Title
Supervised surgical trainees perform thyroid surgery for Graves’ disease safely
Authors
Iyad Hassan
Michael Koller
Conrad Kluge
Sebastian Hoffmann
Andreas Zielke
Matthias Rothmund
Publication date
01-11-2006
Publisher
Springer-Verlag
Published in
Langenbeck's Archives of Surgery / Issue 6/2006
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-006-0077-x

Other articles of this Issue 6/2006

Langenbeck's Archives of Surgery 6/2006 Go to the issue