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Invited Critique |

Effect of Surgeon Expertise on the Outcome in Primary Hyperparathyroidism—Invited Critique

Leigh Delbridge, MD
Arch Surg. 1998;133(10):1071. doi:10.1001/archsurg.133.10.1071.
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The question of who should do or, more importantly, who should be trained to do parathyroid surgery remains controversial. There is no question that parathyroid surgery performed by inexperienced surgeons in an unsupervised setting leads to high failure rates and, presumably, higher rates of reoperation.

The article by Willeke et al compares parathyroidectomy undertaken by "experienced" endocrine surgeons (having perfomed >40 parathyroid procedures themselves) with parathyroidectomy performed by surgeons in training. The results confirm what has been previously demonstrated with respect to other endocrine procedures such as thyroidectomy1; namely, that surgeons in training, provided they are appropriately supervised, can perform complex surgical procedures with the same safety and expected outcomes as experienced surgeons. In this study there was no difference in complication rates or in the rate of a successful outcome (removal of all abnormal glands and biopsy of 1 normal gland), although close supervision by experienced members of faculty in the case of intraoperative problems was implicit in the study. The inexperienced surgeons took longer and were less likely to find all 4 glands, but this did not influence outcome.

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