This is the Website of the London Surgical Endocrinologist John Lynn.
My 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 recognised endocrine surgeon with one of the largest experience of small incision thyroid and parathyroid surgery in the United Kingdom. I have performed in excess of ten thousand endocrine surgical operations. This website represents my own very personal views that have been developed over 30 years of medical and surgical practice. I take great pride in continuing to update this site and to ensure physicians and patients are kept fully informed of advances in endocrine surgery. This website is aimed for both patients and medical professionals of all levels. I have not divided up this website for health care professionals or patients needs but have tried very hard to make it user friendly for all. I am based in Harley Street in central London but do 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. In my experience over 60% of patients are suitable for a minimally invasive approach. Previous neck surgery, nodule size greater than 3cms, thyroid volume of greater than 20 mls and thyroiditis are not in themselves contraindications for small incision surgery.
Few if any NHS district hospitals have all the facilities to treat the whole range of surgical endocrine problems. Patients must not be upset if they are referred to a big city centre as this is very much in their 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, 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 fulfil all these criteria. If patients have any concerns they should ask if all the "boxes" can be ticked and if not, go elsewhere. A review in November 2009 showed that patients operated on in centres 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 physician and in the United Kingdom their GP so as not to be mislead by the Internet. Mr Lynn takes great care in giving up-to-date advice 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 is essential and if not available the patient should seek a centre 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 is very hard on the patient but essential.It protects the patient and the surgeon. It is absolutely essentdial 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 Mr Lynn has noted more and more requests for advice about consent for surgery. It is essential that the patient fully understands risk of complications. The widespread of information sheets is no subsitute 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 listed in this website as well their surgeons experience of "minimally invasive surgery".Most surgeons welcome questions. Patients most never forget that the surgeon is there for their benefit and the majority regard it as a privilige to operate on them.
One is reluctant to claim that one was the "first" to introduce "minimally invasive" thyroid and parathyroid surgery to the United Kingdom. I first performed this method in 1984 aided by Sestamibi scans at the Hammersmith Hospital London.
As stated above I believe, like my American colleagues, that intraoperative recurrent laryngeal nerve monitoring is absolutely mandatory in every thyroid and parathyroid operation. I use the Neurosign 100 in every patient 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 that use it. 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 statistically significant. Long term voice change was also less using the nerve stimulator but did not reach statistical significance, most likely due to the small number of patients studied. (Our recent 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 Continental Europe. The publication of the United Kingdom guidelines for the management of thyroid cancer in 2007 have 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.
Great 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.
On April 6th 2009 I instigated the World Health Organisation (WHO) Surgical Safety Checklist for all surgical patients. All patients will be given a copy of this list after their surgery. Recent world wide studies have demonstrated that the use of the 19 item checklist reduces the rate of complications. The checklist is being introduced by many hospitals in the United Kingdom and will be mandatory in early 2010. Quite extraordinarily, it has been reported that despite the use of a modified WHO Surgical Safety Checklist an operation was performed on the incorrect side of a patient at a major London teaching hospital. At the same institute, due to poor localisation (marking) of the breast, a breast cancer patient had normal breast tissue removed leaving the cancer in the breast. In 2008 NHS London reported eight cases of wrong site, wrong procedure, wrong person surgery in a 12 month period. These episodes in centres of excellence remind us all that surgeons much like airline pilots can never make too many checks - it's check, check and check again! Checklists must not lull the surgeon into a state of false security. As surgeons, we must never be complacent about performing the correct procedure on the correct patient at the correct site. It is my view that the surgeon performing the operation should consent the patient in the ward for surgery, mark the site of the operation, check them in the anaesthetic room and personally perform the WHO Surgical Checklist "timeout". This meticulous protocol does not have universal support in the United Kingdom but in 2013 is mandatory.
The website is large and was last updated on 14/11/2013. To obtain information you can look in the specific sections or else make use of the "Search" option at the top right hand corner or in the footer.
On the July 1st 2013 Mr Lynn published his Thyroid and Parathyroid Surgery results from 11/6/204 until 30/6 2013. This data relates to cases performed outside the NHS.
During this period Mr Lynn has operated privately on 923 thyroid patients without a single death. ( BAETS predicted rate 0.1% -0. 9 cases).There have been two patients with a permanent hoarse voice at 12 months following surgery, a complication rate of 0.21% . No patient suffered unplanned tracheostomy.These results are satisfactory considering the complex case mix but don't make one complacent. There has been a single hospital acquired wound infection (0.1%) and 2 returns to the operating theatre for post operative bleeding (0.21%). All patients are tested as carriers of MRSA prior to surgery and fortunately we have not had a single problem with MRSA. 107 patients underwent a modified neck dissections there has been a single case of permanent acessory nerve palsy (1%) and 2 temporary cases of Horner's Syndrome (2%) . 4O patients were 2nd or 3rd procedures sent to one for previous failed parathyroid surgery or recurrent thyroid cancer and here there was a recurrent nerve palsy rate of 5% (2 patients), emphasing the difficulty of re-do neck surgery. Two thoracic duct injuries settled with conservative treatment but one did take 8 weeks before it settled. 231 patients underwent parathyroid surgery, all primary explored patients had a post-operatively satisfactory calcium. There was very sadly a single post operative death in this group of patients . (0.4%)
The data will be updated on a yearly basis on the first day of January of each year. Mr Lynn will report mortality rates , incidence of voice change , rates of return to theatre for bleeding, rates of infection . Rarer complications such as thoracic duct damage, Horner's Syndrome will also be reported.
If you have any comments or suggestions for the website, please use the contact us menu 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,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 www.rcseng.ac.uk.
This site is 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. Mr Lynn is very happy to give advice via email but always insists that the local physician is involved where at all possible. The Website is archived at The UK Web Archive at www.webarchive.org.uk