title: 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.
abstract: OBJECTIVE
  To determine whether surgeons who had received appropriate training in the technique of total thyroidectomy could continue to perform the procedure with minimal morbidity after moving to a provincial surgical practice.
  
  
  METHODS
  Comparison of the complication rates from total thyroidectomy between a specialized endocrine surgical unit and provincial centers.
  
  
  METHODS
  Six hundred fifty patients undergoing 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 thyroidectomy by seven provincial surgeons who were former trainees in the unit.
  
  
  METHODS
  Indications for surgery and specific complications of thyroidectomy including recurrent laryngeal nerve palsy, permanent hypoparathyroidism, and postoperative bleeding.
  
  
  RESULTS
  Each of the seven surgeons in provincial practice performed only between two and 16 thyroidectomies annually. The percentage of total thyroidectomies for benign and malignant disease was identical for both the endocrine surgical unit and provincial center groups (44%). There was no difference in the incidence of recurrent laryngeal nerve palsy, permanent hypoparathyroidism, or postoperative bleeding between the two groups.
  
  
  CONCLUSIONS
  Total thyroidectomy is an operation that always engenders controversy relating to the morbidity of recurrent laryngeal nerve and parathyroid injury. Surgeons who have completed a well-designed training 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 meticulous attention to operative technique and anatomical detail.
authors.affiliation: Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, Australia.
authors.forename: T S
authors.initials: TS
authors.lastname: Reeve
authors.forename: A
authors.initials: A
authors.lastname: Curtin
authors.forename: L
authors.initials: L
authors.lastname: Fingleton
authors.forename: P
authors.initials: P
authors.lastname: Kennedy
authors.forename: W
authors.initials: W
authors.lastname: Mackie
authors.forename: T
authors.initials: T
authors.lastname: Porter
authors.forename: D
authors.initials: D
authors.lastname: Simons
authors.forename: D
authors.initials: D
authors.lastname: Townend
authors.forename: L
authors.initials: L
authors.lastname: Delbridge
mesh_terms: D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D006780:Hospitals, Rural / Q000592:standards*; D006801:Humans; D009517:New South Wales; D012189:Retrospective Studies; D012449:Safety; D013503:Surgery Department, Hospital / Q000592:standards*; D013965:Thyroidectomy / Q000592:standards*