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Can Total Thyroidectomy Be Safely Performed by Residents?: A Comparative Retrospective Multicenter Study
Angela Gurrado1, Rocco Bellantone, Giuseppe Cavallaro
1From the Department of Biomedical Sciences and Human Oncology (AG, GDM, AP, MT), University Medical School of Bari, Bari; Department of Surgery (RB, CPL, MR), University Medical School "Cattolica del Sacro Cuore," Rome; Department of Medical and Surgical Sciences and Biotechnologies (GC), University Medical School "La Sapienza," Rome; Department of Surgery (MC, MI), Oncology and Gastroenterology, University of Padova, Padova; Department of Anesthesiology (GC, GD, ST), Surgical and Emergency Sciences, Second University of Naples, Naples; Department of Surgical (GM, PM), Medical, Molecular Pathology, Critical Area, University Medical School of Pisa, Pisa; Department of Surgical Sciences (MM), University Medical School of Genoa, Genoa, Italy; Department of Thyroid and Endocrine Surgery (VC, FP), Imperial College London, London, UK; and Department of General and Endocrine Surgery (IFF, FS), Hôpital de la Timone, Marseille, France.
Total thyroidectomy (TT) performed by resident surgeons (RS) with attending surgeon (AS) supervision shows comparable outcomes to AS-performed TT. Junior RS experienced higher morbidity, indicating a need for structured training programs to ensure patient safety in endocrine surgery.
Area of Science:
- Endocrine Surgery
- Surgical Education
- Patient Outcomes
Background:
- Total thyroidectomy (TT) is a common endocrine surgery procedure.
- Evaluating patient outcomes based on surgeon experience is crucial for surgical training and patient safety.
- Multicenter studies are essential for robust analysis of surgical outcomes.
Purpose of the Study:
- To compare patient outcomes of total thyroidectomy (TT) performed by resident surgeons (RS) under close attending surgeon (AS) supervision versus TT performed by attending surgeons.
- To analyze the impact of different levels of resident surgeon experience and supervision on operative time, length of hospitalization, and postoperative complications.
Main Methods:
- Retrospective comparative multicenter study involving 8908 patients undergoing TT between 2009 and 2013 across 10 endocrine surgery units in Europe.
- Patients were categorized into three groups: Group A (AS assisted by RS), Group B (junior RS assisted by AS), and Group C (senior RS assisted by AS).
- Data collected included demographics, operative details, drain usage, hospitalization length, and postoperative complications.
Main Results:
- Operative time was significantly longer for junior RS (Group B) compared to AS-assisted (Group A) and senior RS-assisted (Group C) procedures.
- Postoperative morbidity was significantly higher in junior RS (Group B) compared to both Group A and Group C.
- No significant differences were observed in rates of recurrent laryngeal nerve palsy, hypoparathyroidism, hemorrhage, or wound infection among the groups.
Conclusions:
- Total thyroidectomy can be safely performed by resident surgeons with appropriate attending surgeon supervision.
- Junior resident surgeons may experience higher morbidity, highlighting the importance of structured, gradual training in high-volume centers.
- Implementing innovative training programs can enhance resident autonomy and safeguard patient outcomes in endocrine surgery.
