Committed to safety and excellence in Endocrinology and Minimally Invasive Thyroid, Parathyroid and Endocrine surgery
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 most likely the largest experience of small incision thyroid and parathyroid surgery in the United Kingdom. I have performed in excess of approximately ten thousand endocrine surgical operations. The website represents my own very personal views developed over 30 years of medical and surgical practice. I take great pride in constantly updating the site so that physicians and patients are kept fully informed of advances in endocrine surgery. The website is aimed both at patients and medical professionals of all levels. I have not divided up the website for health care professionals or patient's needs but have tried very hard to make it user friendly for all. I am based in Central London but do travel all over the world to perform complex thyroid and parathyroid surgery. The approach I use for thyroid and parathyroid operations is called "minimally invasive surgery". This method reduces in patient stay to one night, does not involve painful drains. Postoperative pain is minimal as the muscles in the neck are not cut and most incisions for parathyroidectomy and thyroidectomy are only 2 cms long.
Few if any NHS District hospitals have all the facilities to treat the whole range of surgical endocrine problems. The patient must not be upset if they are referred to a big city centre. This is very much in their interests. In my view for safe endocrine surgery to to be performed certain basic criteria most be fulfilled. There must be 24 hour resident staff. The ward should be experienced in dealing with endocrine cases. There must be an intensive care unit on site that is staffed 365 days in the year. These criteria are always fulfilled by NHS hospitals but may not be in the private sector. Private hospitals outside London do not usually fulfill all these criteria. If the patients has any concerns they should ask and if the "boxes" cannot be ticked go elsewhere. A review in November 2009 showed that patients operated in centres with a low volume of thyroid cancer were likely to have inadequate operations and be at risk of cure. (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 accord 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 UK their GP so as not to be mislead by the Internet. This website takes great care in giving up to date advice but is in no way a substitute for advice by a patient's own physician.
Few in any endocrine surgeons would quibble with the above statements. In addition I believe that for thyroid and parathyroid surgery nerve monitoring, intraoperative pathology and intra-operative pth measurement is essential and if not available the patient should seek a centre where they are.
These are not trivial requirements and coupled with informed consent problems 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 essential that the patient fully understands the implications of the surgery and if he or she is unclear to ask the surgeon to explain any point that is of concern. Finally 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."
One is reluctant to claim that one was the "first" to introduce "minimally invasive" thyroid and parathyroid surgery to the UK. I first performed this method in 1984 aided by Sestamibi scans at the Hammersmith Hospital London.
I believe, like my American colleagues, that intra-operative 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 UK 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.
There have been concerns in the past about the standard of care offered to patients in the UK with endocrine surgical problems. This is particularly true of thyroid cancer, where results of treatment in the UK were significantly worse than those in the USA and Continental Europe. The publication of the UK 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 UK. 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, (BAETS) who in 2009 published their 3rd National Audit Report of endocrine surgery in the UK . This can be accessed at www.baes.info
From April 6th 2009 I instigated the World Health Organisation (WHO) Surgical Safety Check list 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 check list reduces the rate of complications. The check list 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 Check list that an operation was performed on the incorrect side of the patient at a Major London Teaching Hospital. At the same institute a breast cancer patient has had due to poor localisation (marking) normal breast tissue removed and the cancer left in the breast. In 2008 NHS London reported 8 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 like the airline pilots can never make too many checks! Its check, check and check again. Check lists 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. Its Mr Lynn's 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 will be in "part" mandatory in 2010.
This website is very large and was last updated on February 1st 2010.Please make use of the Search option in the left-hand menu or in the footer.
If you have any comments or suggestions for the website, please make contact through the options on the left-hand menu. 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 a 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
Mrs Rosalind Jones my practice manager of 30 years died suddenly on the 23rd of October 2008. Rosalind helped hundreds of patients with her kind manner and care. She was admired by all for her wonderful elegance and intellect. Her integrity was cast iron. She is sorely missed by so many patients who regarded her as a great friend.
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 will always insist that the local physician is involved where at all possible.