Future of thyroid surgery and training surgeons to meet the expectations of 2000 and beyond

What is the future of thyroid surgery in the new millennium? How can surgeo ns keep abreast of advances in thyroid endocrinology, genetics, surgical th erapy, and other aspects of thyroid disease management? How should surgeons be trained to become highly competent in thyroid disease and to perform sa fe, effective thyroid operative procedures? Nine internationally recognized endocrine surgeons were asked to express their views on these and related subjects. They noted that advances in molecular biology, pathology, and gen etics of thyroid disease should allow more tailored surgical approaches dur ing the twenty-first century, Current training of general surgical resident s in thyroid and other types of endocrine surgery is highly variable, which may contribute to increased complication rates and number of second operat ions. The leadership for addressing these deficiencies and promoting a more organized approach to thyroid disease management should come from national endocrine surgery associations and their leaders. It is incumbent upon end ocrine surgeons to maintain their central role in the management of many as pects of thyroid disease. Organizing teams of specialists into thyroid cent ers (centers of excellence) can (1) increase efficiency; (2) increase quali ty of care; (3) decrease costs; ( 1) encourage a more individualized approa ch to surgery; (5) lower complication rates; and (6) foster innovation in t echnology and disease management. Two years of additional fellowship traini ng in thyroid and endocrine surgery is now being advocated by increasing nu mbers of national endocrine surgical associations as the best way to prepar e surgeons for society's needs for highly skilled, competent thyroid surgeo ns of the future.