Patient, thyroid, and surgeon related factors that make thyroidectomy difficult-cohort study

Area of Science:

• Surgical Education and Training
• Endocrine Surgery
• Surgical Outcomes and Assessment

Background:

• Thyroidectomy, while generally safe with optimal technique, carries risks of life-threatening complications.
• Predicting surgical difficulty is crucial for patient safety and optimizing outcomes.
• Factors influencing thyroidectomy difficulty can be related to the patient, thyroid gland, or surgeon.

Purpose of the Study:

• To identify factors predicting difficult thyroidectomy.
• To develop and validate a modified thyroidectomy difficulty scale (TDS).
• To assess surgeon's physiological response during thyroidectomy.

Main Methods:

• Prospective study in a tertiary care center (September 2016 - March 2017).
• Development and validation of an 11-item modified TDS.
• Preoperative patient parameter recording; postoperative blinded TDS completion by surgeon and assistant.
• Surgeon's pulse rate monitored using an On-The-Go (OTG) compatible pulse oximeter connected to an Android application.

Main Results:

• 52 patients undergoing thyroidectomy included; all had benign cytology.
• 104 modified TDS questionnaires analyzed, showing interobserver agreement except for mobility.
• Surgeon's pulse rate recorded in 52 surgeries (mean score 26.85 ± 2.80).
• Maximum surgeon heart rate occurred during recurrent laryngeal nerve (RLN) dissection in 73.07% of cases.

Conclusions:

• Thyroidectomy is perceived as an intensely demanding surgical procedure by trainees.
• Meticulous identification and dissection of the recurrent laryngeal nerve (RLN) and parathyroid glands are critical for optimal thyroidectomy outcomes.
• The modified TDS and surgeon's physiological monitoring offer insights into surgical demand.