• Angela Gurrado, Rocco Bellantone, Giuseppe Cavallaro, Marilisa Citton, Vasilis Constantinides, Giovanni Conzo, Giovanna Di Meo, Giovanni Docimo, Ilaria Fabiola Franco, Maurizio Iacobone, Celestino Pio Lombardi, Gabriele Materazzi, Michele Minuto, Fausto Palazzo, Alessandro Pasculli, Marco Raffaelli, Frederic Sebag, Salvatore Tolone, Paolo Miccoli, and Mario Testini.
• From 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.
• Medicine (Baltimore). 2016 Apr 1; 95 (14): e3241e3241.

AbstractThis retrospective comparative multicenter study aims to analyze the impact on patient outcomes of total thyroidectomy (TT) performed by resident surgeons (RS) with close supervision and assistance of attending surgeons (AS).All patients who underwent TT between 2009 and 2013 in 10 Units of endocrine surgery (8 in Italy, 1 in France, and 1 in UK) were evaluated. Demographic data, preoperative diagnosis, extension of goiter, type of surgical access, surgical approach, operative time, use and duration of drain, length of hospitalization, histology, and postoperative complications were recorded. Patients were divided into 3 groups: A, when treated by an AS assisted by an RS; B and C, when treated by a junior and a senior RS, respectively, assisted by an AS.The 8908 patients (mean age 51.1 ± 13.6 years), with 6602 (74.1%) females were enrolled. Group A counted 7092 (79.6%) patients, Group B 261 (2.9%) and Group C 1555 (17.5%). Operative time was significantly greater (P < 0.001) in B (101.3 ± 43.0 min) vs A (71.8 ± 27.6 min) and C (81.2 ± 29.9 min). Duration of drain was significantly lower (P < 0.001) in A (47.4 ± 13.2 h) vs C (56.4 ± 16.5 h), and in B (42.8 ± 14.9 h) vs A and C. Length of hospitalization was significantly longer (P < 0.001) in C (3.8 ± 1.8 days) vs B (2.4 ± 1.0 days) and A (2.6 ± 1.5 days). No mortality occurred. Overall postoperative morbidity was 22.3%: it was significantly higher in B vs A (29.5% vs 22.3%; odds ratio [OR] 1.46, 95% confidence interval [CI] 1.11-1.92, P = 0.006) and C (21.3%; OR 1.55, 95% CI 1.15-2.07, P = 0.003). No differences were found for recurrent laryngeal nerve palsy, hypoparathyroidism, hemorrhage, and wound infection. The adjusted ORs in multivariate analysis showed that overall morbidity remained significantly associated with Group B vs A (OR 1.48, 95% CI 1.12-1.96, P = 0.005) and vs C (OR 1.60, 95% CI 1.19-2.17, P = 0.002), while no difference was observed in Group A vs B + C.TT can be safely performed by residents correctly supervised. Innovative gradual training in dedicated high-volume hospitals should be proposed in order to allow adequate autonomy for the RS and safeguard patient outcome.

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