Mr John Lynn, Endocrine Surgeon

Mr John Lynn MS FRCS, Endocrine Surgeon

I have been for 40 years been a Fellow of the Royal College of Surgeons of London.For 29 years I was the sole Consultant Surgical Endocrinologist at the Hammersmith Hospital, London and Honorary Senior Lecturer in the Department of Surgery, Imperial College of Science, Medicine and Technology. In my career I have performed in excess of ten thousand explorations of the neck.

I now practice only privately at  the Weymouth Hospital, Weymouth Street  London , King Edward VII Hospital London and at the Parkside Hospital Wimbledon. My main interest is the safe application of minimally invasive surgery for endocrine conditions.

I have had an interest in endocrine surgery for 30 years. I qualified from King's College Hospital, London in 1964 and was appointed house physician to the Professorial Medical Unit at Kings College Hospital and subsequently was house surgeon to Sir John Wakeley at the Chester Royal Infirmary. In 1976 I became casualty officer at the Birmingham Accident Hospital, and then worked for 18 months as a general practitioner in South London while studying for the primary fellowship of the Royal College of Surgeons of England. In 1967 I went to Ascension Island with the BBC as a general practitioner with a surgical interest. Following this period abroad I had an extensive surgical training as a surgical registrar in Liverpool and Chester in Cheshire.

I spent 18 months from 1971 with Dr Richard Egdahl learning endocrine surgery at the Boston University Medical Centre in Massachusetts, USA. When in Boston, Endocrine surgery was very much in its infancy in the UK. The major centre in the UK was the Hammersmith Hospital. While in Boston, in my spare time I was a medical officer for a drug addiction clinic. From 1973 I was senior registrar for 2 years at the District General Hospital in Bournemouth in the South of England. I returned to London to the Westminster Hospital as a senior registrar in 1975 for a spell of 2 years training in the the head and neck unit under Mr Gerald Westbury. In 1977 I was appointed Lecturer in Professor Harold Ellis' Surgical Department at Westminster Hospital Medical School, London. In the same year I was awarded the Arris and Gale Lectureship of the Royal College of Surgeons of London. In 1978 I was awarded the Mastership in Surgery of the University of London for my dissertation on "The Effects of female hormones on bile composition - a Study in a Primate model".

In 1978 I was appointed consultant surgeon to the Hammersmith Hospital with a special interest in thyroid and parathyroid surgery. At the same time I had general surgical responsibilities at the newly opened Ealing Hospital in West London. In 1979 I was awarded an honorary senior lectureship to the Royal Postgraduate Medical School London. For 29 years at Hammersmith Hospital my special interests were the medical and surgical treatment of thyroid disease, the management of parathyroid disease and re-operative surgery. I developed a special expertise in the management of endocrine tumours of the pancreas and of benign and malignant tumours of the adrenal including functional tumours such as phaeochromocytoma, Cushing's and Conn's tumours.

In the 1985 I introduced minimally invasive endocrine surgery to the Hammersmith Hospital.

From 2006 I have dedicated all of my time to private practice in London and abroad. I am certainly one of the most experienced practicing endocrine surgeons in the United Kingdom.

I operated on or assisted at 445 endocrine operations in 2005-6. Since leaving the NHS I perform approximately 200 thyroid or neck explorations a year at London Hospitals

I have lectured worldwide and published extensively on all aspects of endocrine surgery (please see his publications and presentations). I have worked for 30 years with the distinguished Endocrine Pathologist Dr Paul Lewis and a team of Endocrinologists, Radiologists and Anaesthetists who have a special interest in endocrine tumours. My research interests are mainly clinical with a particularly interested in the difficult problem of re-operative endocrine surgery. I also have a special interest in paediatric surgical endocrinology. For 15 years I have advocated early operative intervention in young children who are Ret proto-oncogene positive from families with medullary cancer of the thyroid. This view is now considered the gold standard. In the last 29 years I has trained over 20 consultant surgeons who have developed either a part or full-time interest in endocrine surgery.

I was a founder member of the British Endocrine Surgical Group, later known as the British Association of Endocrine Surgeons, recently renamed the British Association of Endocrine & Thyroid Surgeons (BAETS). An audit of thyroid and parathyroid surgery by the BAETS in 2007 prior to retirement from the NHS IN 2006 confirmed that the Endocrine Unit Team had the the largest thyroid and parathyroid surgical practice in the UK.

I have voiced my concerns for many years about the apparent high incidence of complications following thyroid and parathyroid surgery performed by non specialist surgeons or surgeons with an alleged interest in parathyroid or thyroid surgery but a low yearly volume. As a result of my published concerns I have developed a medical legal practice related to complications following thyroid and parathyroid surgery.

The t BAETS audit in 2007 demonstrated a re-operation rate for bleeding in thyroidectomy of 1.25% as compared with my rate of 0.2%. The study also showed permanent damage to the parathyroids of 7.56% following thyroidectomy as compared to my rate of less than 3%.

I perform all his surgery using specially custom made illuminated magnifying loupes very kindly donated by one of my thyroidectomy patients. These loupes are an enormous aid in improving the safety of the surgery.

I am convinced that intra-operative nerve monitoring of the recurrent laryngeal nerve should be performed in all parathyroid and thyroid operations. This attitude is not supported by all endocrine surgeons but is justified in my view by the fact that an audit in 2007 by the BAETS showed that its members who do not universally use nerve monitoring had a mean damage to the major voice box nerve following thyroidectomy of 2.2% and a voice change rate of 5.9% as compared to 0.2% for both in my hands. The National Institute for Clinical Excellence (NICE) in 2007 asked for advice about the use of intra-operative nerve monitoring and I was disappointed with its March 2008 verdict. NICE confirms that there is no risk using the nerve monitor but did not recommend its universal use. Interestingly NICE commented on its value in complicated thyroidectomies. Some of the advisors to NICE were concerned about its use by inexperienced surgeons who in my view should not be doing the operation anyway! I hope that more and more surgeons will use this useful method and that like identifying the laryngeal nerves, that nerve monitoring is in the future considered essential in thyroid and parathyroid surgery. My recent experience of nerve monitoring in 820  consecutive cases (up to June 2010) has convinced me this the case. Intra-operative nerve monitoring is not a substitute for meticulous recurrent nerve identification but is an additional aid in protecting the nerve. The use of nerve monitoring may be in part hampered by the question of cost and one hopes that it does not become part of the "postcode lottery" so widespread in England.

In July 2007 I was instructed as an expert witness on behalf of General Medical Council regarding the use of Thyroxine in biochemically euthyroid patients.

In 2007 I gave the Yearsley Lecture of the Royal Society of Medicine and ENT UK and was awarded the Yearsley Gold Medal.

In March 2008 I gave the Thomas Tatum memorial lecture on Head and Neck Surgery at St George's Hospital London.

In March 2012 I Lectured in Saudia Arabia on thyroid cancer

In 2013 I lectured to post graduates surgical trainee on various aspects of surgical technique.

William Lynn MRCS Bsc (Hons) MBBS (Distinction), my son is a Surgical Trainee at level ST3 in the North East Thames Deanary while Ann Drury MBBS FRCR, my wife is a Consultant Oncologist with a special interest in thyroid cancer,breast cancer and sarcomas.

I am the owner of Worgret Manor Bed and Breakfast, a Georgian Manor House famed for its accommodation in Wareham in Dorset. Wareham is the gateway to the Purbecks, part of the World Heritage Dorset Coast.