Occurrence and Prevention of Complications in Thyroid Surgery

Job Kievit, MD, PhD ■ Bert A. Bonsing, MD, PhD ■ Ilfet Songun, MD, PhD ■ Cornelis J.H. van de Velde, MD, PhD

The first surgeon to receive the Nobel Prize in medicine was Theodor Kocher (1841-1917) in 1909, a pioneer in thyroid surgery. One of his accomplishments was to reduce the frequency of thyroid surgery complications. The refinements of his surgical methods from his first important article on thyroidectomy (1878) led to a reduction in mortality from high initial figures (50%) to less than 4.5%. Currently, the mortality rate of thyroidectomy, as reported in several large series, approaches zero. The morbidity of thyroidectomy, however, continues to be a matter of concern. Meticulous attention to operative technique is required, as is a flexible approach that balances the requirements of resection to avoid recurrences against the risk of complications. In 1989, in the United Kingdom, surgical claims for thyroidectomy complications accounted for 4% of general surgical claims, all of which involved recurrent laryngeal nerve injury.1 Claims under-represent complications, and complications in routine care may occur more frequently than in published series. Most complications of thyroidectomy can be avoided by detailed knowledge of the anatomy and careful surgical technique. Although it is a surgical truism that volume generally improves quality, recent research suggests that surgeons may differ in their ability to perform this refined surgery with sufficient care.2 Regardless of the background of the surgeon (general surgeon, head and neck surgeon, or endocrine surgeon), the collaboration with an endocrinologist and broad experience in thyroid surgery not only will improve quality but will give confidence in any legal challenge and will help educate future surgeons in proper surgical decision making and technique.

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