Surgical training and vocal-cord paralysis in benign thyroid disease

Introduction: Operations performed by a trainee surgeon should not result in a higher risk of complications. However, there is little information about identifying risk factors for primary surgery of benign, non-autoimmune goiter. Methods: This study correlates experience of the surgeon and other potential risk factors with palsy rates of the recurrent laryngeal nerve over an 18-month period. Radical removal of all nodular thyroid tissue and principal nerve identification were standard procedures. Results: Of a total of 405 operations per side, 55.8% were subtotal resections, 11.8% extended subtotal (near total) resections and 33.1% lobectomies. The overall initial and permanent palsy rates of “nerves at risk” were 8.9% and 1.2%, respectively. Patients' age, gender and weight, as well as endocrine activity of the thyroid gland were not associated with increased complications. Conclusion: The risk of nerve damage increased significantly and independently with size of goiter and extent of resection, but did not correlate with the surgical experience. In conclusion, the training of surgeons is safe if cases are carefully selected and the surgeons in training are supervised.