CAN TOTAL THYROIDECTOMY BE PERFORMED AS SAFELY BY GENERAL SURGEONS INPROVINCIAL CENTERS AS BY SURGEONS IN SPECIALIZED ENDOCRINE SURGICAL UNITS - MAKING THE CASE FOR SURGICAL TRAINING

Objective: To determine whether surgeons who had received appropriate training in the technique of total thyroidectomy could continue to per form the procedure with minimal morbidity after moving to a provincial surgical practice. Design: Comparison of the complication rates from total thyroidectomy between a specialized endocrine surgical unit and provincial centers. Setting and Patients: Six hundred fifty patients u ndergoing total thyroidectomy by two surgeons over a 5-year period in the endocrine surgical unit at Royal North Shore Hospital, St Leonards , Australia, were compared with 120 patients undergoing total thyroide ctomy by seven provincial surgeons who were former trainees in the uni t. Main Outcome Measures: Indications for surgery and specific complic ations of thyroidectomy including recurrent laryngeal nerve palsy, per manent hypoparathyroidism, and postoperative bleeding. Results: Each o f the seven surgeons in provincial practice performed only between two and 16 thyroidectomies annually. The percentage of total thyroidectom ies for benign and malignant disease was identical for both the endocr ine surgical unit and provincial center groups (44%). There was no dif ference in the incidence of recurrent laryngeal nerve palsy, permanent hypoparathyroidism, or postoperative bleeding between the two groups. Conclusion: Total thyroidectomy is an operation that always engenders controversy relating to the morbidity of recurrent laryngeal nerve an d parathyroid injury. Surgeons who have completed a well-designed trai ning program and who have become proficient at total thyroidectomy as trainees will remain proficient at the procedure despite practicing in a provincial center. Achieving a low morbidity rate demands meticulou s attention to operative technique and anatomical detail.