Who should perform thyroid surgery? United Kingdom (UK) and United States (US) perspectives with recommendations

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Historically, in the United States and Europe, thyroid surgery has fallen within the domain of the general surgeon [1]. To date, most thyroid operations have been completed by surgeons without specialist or sub-specialist interest [2]. Approximately 75% of thyroid operations in the US and UK are performed by low volume surgeons (less than 35 operations over a 2 year period) [2, 3]. It has been demonstrated that the units participating in high volume surgery improve training opportunities and reduce both complications and the length of inpatient stay [4, 5]. Indeed, the length of stay decreases and the training exposure improves as the volume of surgery increases as shown in a busy UK thyroid surgical unit (Figs. 1, 2). As well as having training implications, annual workload within units has implications for membership of some thyroid cancer multidisciplinary meetings (MDT) [3]. These factors shift the paradigm towards specialisation and regional concentration of cases. Thyroid surgery is increasingly performed by surgeons with fellowship training in endocrine or head and neck disease. This includes surgeons in the UK and US with not only a background in general surgery but, more and more, head and neck surgeons with a background in otolaryngology [1].

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