Welcome to EndocrineSurgeon.co.uk
Committed to safety and excellence in endocrinology and minimally invasive thyroid, parathyroid and endocrine surgery
This is the website of the London Endocrine Surgeon Mr John Lynn.
Located at 9 Harley Street, London W1 9AL
Telephone for appointments +44 (0) 20 7079 2100
Practice Manager Alina +44 (0) 7836 285 832 (24 hour mobile)
This website aims to provide comprehensive, authoritative and up-to-date information on all aspects of endocrine surgery for patients, medical students and qualified practitioners of all levels. I am an internationally recognized endocrine surgeon with much experience in small incision thyroid and parathyroid surgery in the United Kingdom.
I have performed in excess of ten thousand endocrine surgical operations and this website represents my own views that have been developed over 30 years of medical and surgical practice. I take great pride in continuing to update this site to ensure physicians and patients are kept fully informed of advances in endocrine surgery and have tried to make it user friendly for all.
I am primarily based at Harley Street in central London but travel all over the world to perform complex thyroid and parathyroid surgery. The approach used for thyroid and parathyroid operations is called "minimally invasive surgery". This method reduces in-patient stay to one night and does not involve painful drains. Postoperative pain is minimal, as the muscles in the neck are not cut. Most incisions for parathyroidectomy and thyroidectomy are only 2 cm long (mini-thyroidectomy/mini-parathyroidectomy). Some cases are not suitable for mini surgery but even then patients are surprised how small the neck wound is. A recent study presented to the British Association of Thyroid and Endocrine Surgeons (BAETS) in 2010 from Hammersmith Hospital, London suggests that only 10% of patients in the UK are suitable for minimally invasive thyroidectomy. This is not my view as in my experience over 60% of patients are suitable for a minimally invasive approach. Previous neck surgery, nodule size greater than 3 cm, thyroid volume of greater than 20 mL and thyroiditis are not in themselves contraindications for small incision surgery.
Few if any NHS district hospitals have all the facilities necessary to treat the whole range of surgical endocrine problems. Patients must not be upset if they are referred to a big city center, as this is very much in their best interests. In my view for safe endocrine surgery to be performed certain basic criteria must be fulfilled: there must be a 24 hour resident on site and the ward should be experienced in dealing with endocrine cases. These criteria are always fulfilled by NHS hospitals, however private hospitals outside London do not usually fulfill these criteria. If patients have any concerns they should ask if all the "boxes" can be ticked and if not, then they must go elsewhere. A review in November 2009 showed that patients operated on in centers with a low volume of thyroid cancer were likely to have inadequate operations and therefore may not be cured of their disease (J.C Lifante et al British Journal Surgery 2009, 96, 1284-1288).
The Internet is littered with medical sites that are commercial or misinformed. In August 2009 McLean and Delbridge, an Australian group of endocrine surgeons reported about a 30% incidence of erroneous information in websites dedicated to parathyroid surgery. They stated "websites contained statements which were not in accordance with the evidence base, manipulative of the truth or simply false". This report stresses how important it is for patients to always seek advice from their own physicians so as not to be misled by the internet. I take great care in giving up-to-date advice on this website but this is in no way a substitute for advice by a patient's own physician.
Few if any endocrine surgeons would disagree with the above statements. In addition, I believe that for thyroid and parathyroid surgery, nerve monitoring, intraoperative pathology and intraoperative PTH measurement are essential. If they are not available the patient should seek a center where they are.
Informed consent problems are the source of most complaints by patients. Prior to surgery the surgeon will discuss all possible complications of the surgical procedure. This may be very hard on the patient but it is essential that the patient is fully informed as it protects both the patient and the surgeon. It is absolutely essential that the patient fully understands the implications of the surgery and if he or she is unclear, they must ask the surgeon to explain any point that they do not understand. Recently I have noted more and more requests for advice about consent for surgery. The widespread notion of information sheets is no substitute for a face-to-face explanation of the surgical risks. Patients should ask about their surgeon's volume of work and incidence of his or her complications as well their surgeon’s experience of "minimally invasive surgery". Most surgeons welcome questions and patients should never forget that the surgeon is there for their benefit and the majority regard it as a privilege to operate on them.
One is reluctant to claim that one was the "first" to introduce "minimally invasive surgery" for the thyroid and parathyroid to the United Kingdom. I first performed this method in 1984 and was aided by Sestamibi scans at the Hammersmith Hospital in London.
Like my American colleagues, I believe that intraoperative recurrent laryngeal nerve monitoring is absolutely mandatory in every thyroid and parathyroid operation. I use the Neurosign 100 on every patient who is having neck surgery (www.magstim.com). Nerve monitoring is now widely available in the United Kingdom and I suggest that patients ask to be operated on only by surgeons who employ its use in their operating theatre. I am convinced that it reduces the risk of voice change following neck surgery. A recent study from Poland has confirmed that using a nerve stimulator reduced the incidence of short-term voice change, which was proved to be statistically significant. There was also less long-term voice when using the nerve stimulator but this did not reach statistical significance. One reason for this may be due to the small number of patients studied. (Our own experience is in excess of 1300 patients operated in London).
There have been concerns in the past about the standard of care offered to patients in the United Kingdom with endocrine surgical problems. This is particularly true of thyroid cancer, as results after treatment in the United Kingdom were significantly worse than those in the USA and that of Continental Europe. The publication of the United Kingdom guidelines for the management of thyroid cancer in 2007 has in part allayed ones fears. A matter for grave concern is the low volume of thyroid and parathyroid surgery performed by a significant number of surgeons in the United Kingdom. This is particularly the case in the management of parathyroid tumours. I am regularly asked to explore patients whose first attempt at surgery has failed, all too often due to the inexperience of the initial surgeon. Credit must be given to the British Association of Endocrine and Thyroid Surgeons, who in 2009 published their 3rd National Audit Report of endocrine surgery in the United Kingdom; this can be accessed at www.baes.info.
The website was last updated on 01/10/2014 To obtain information you can look in the specific sections or make use of the "Search" option at the top right hand corner or in the footer.
On 01/06/2013 I published my Thyroid and Parathyroid Surgery results from 30/06/2013-11/6/2014. This data relates to cases performed outside the NHS.
During this period I have operated privately on 923 thyroid patients without a single death (BAETS predict a rate of 0.1-0.9%). There have been two patients with a permanent hoarse voice at 12 months following surgery (0.21%). No patients suffered an unplanned tracheostomy.
These results are satisfactory considering the complex cases that I am involved in but it doesn’t make one complacent. There has been a single hospital acquired wound infection (0.1%) and two returns to the operating theatre for post-operative bleeding (0.21%). All patients are tested as carriers of MRSA prior to surgery and as a result we have not had a single problem with MRSA. 107 patients underwent a modified neck dissection and there has been a single case of temporary accessory nerve palsy (1%) and two temporary cases of Horner's Syndrome (2%). 40 patients were either second or thyroid procedures, which were sent to me after previous failed parathyroid surgery or recurrent thyroid cancer and from this pool, two patients developed a recurrent nerve palsy (5%), emphasizing the difficulty of re-do neck surgery. Two thoracic duct injuries settled with conservative treatment but one did take eight weeks before it settled. 231 patients underwent parathyroid surgery. All primary explored patients had post-operatively satisfactory calcium. Very sadly, there was a single post-operative death in this group of patients (0.4%).
I will continue to report mortality rates, incidence of voice change, rates of return to theatre for bleeding and rates of infection. Other rare complications including thoracic duct damage and Horner's Syndrome will also be reported.
I am obsessive with checking MRSA* in patients as all is required is a simple nasal swab, in over 10 years we have had no MRSA infections. This is in part due to the fact that we have tested everyone and have been prompt in administering treatment if they test MRSA positive.
*Meticillin resistant Staphlococcus aureus (MRSA) is a bacterial infection that is resistant to many widely used antibiotics. It can spread through contact. If this bacteria gets into an open wound in the skin, it can cause life threatening conditions such as blood poisoning and endocarditis. MRSA can be treated with an antibiotic nasal ointment, antiseptic mouthwash and an antiseptic skin wash. Good hand hygiene will reduce the risk of spreading MRSA.
If you have any comments or suggestions for the website, please use the contact us option. Your comments help me to maintain the highest possible standard of endocrine surgery. I encourage my patients to comment on my standard of care. One excellent way to do this is to comment on the website www.iwantgreatcare.org. Endocrine Surgery is not listed on this website so comments are best posted under Endocrinology. Your comments are of great value not only to me but to prospective patients. I adhere strictly to the ethical principles laid out in "Good Surgical Practice" published by The Royal College of Surgeons of England in February 2007, which can be found on their website.
Mr John Lynn MS FRCS
Consultant Endocrine Surgeon
This site dedicated for educational and teaching purposes only. It is in no way intended to replace medical advice given in the consultation room by a qualified doctor. Any individuals with concerns about their health should first consult their physician and then seek an endocrine surgical referral if necessary. I am very happy to give advice via email but will always insist that the local physician is involved where at all possible.
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