Debate: In Favor of Transoral Thyroid Surgery

Most medical lectures can be pretty dull, but I had the chance last weekend to participate in a different kind of event: a live debate. At the American Thyroid Association annual meeting in Scottsdale, AZ, I was able to debate (and rebut) Harvard surgeon Dr Sareh Parangi about the value of remote access "scarless" thyroid surgery. While there were no fisticuffs, it is clear that we have differences of opinion!

First, I should say that Dr Parangi is an excellent surgeon who is very well regarded. In fact, she is the new president of the American Association of Endocrine Surgeons, one of the largest groups of endocrine surgeons in the USA. She trained as a general surgeon, which is different than my background as a Head and Neck Surgeon.

From my point of view, while I'm not employed by a university anymore, I did spend a decade at Johns Hopkins, where I rose to become the Director of the Multidisciplinary Thyroid Tumor Center. I am one of only 100 surgeons in the US to be accredited by the American Board of Otolaryngology Head and Neck Surgery in Complex Thyroid/Parathyroid Surgery. Finally, I was the most recent president of the North American Society for Interventional Thyroidology, which is the largest group of physicians in the USA focused on finding, testing, and improving new techniques for managing the thyroid. In other words, I'm no slouch.

(For those of you keeping score at home, this is how nerdy doctors describe their stats: while we don't talk about how much we bench press or how fast we run, we are happy to share the number of publications we have!). And, when you have two of the best thyroid surgeons in America debating, you know that we will have opinions!

I got to go first, and I had 5 minutes to extol the virtues of thyroid surgery without a visible scar. I brought up the following:

1- Scarless thyroid surgery s just as safe, and patients have a better quality of life after scarless thyroid surgery.

2- people almost always EVENTUALLY care about their thyroid scar, even if they are more worried about something else (in fact, almost 80% of patients complain about their scar after thyroid surgery!). Scarless parathyroid surgery eliminates that concern.

3- scarless thyroid and parathyroid surgery use cameras. By using cameras, it allows us to add new technologies that can eventually make surgery even safer and better just like your car can help you drive safer by telling you if there is someone in your blind spot before you merge (I showed some videos of this in surgery).

I also described how my first thousand patients have done, and the incredible outcomes that they have had according to some of the research that we have published.

Dr Parangi responded that we should not be doing scarless thyroid surgery for 3 reasons:

1- it's more expensive and takes longer than traditional thyroid surgery

2- not very many people are eligible for remote access thyroid surgery

3- it's hard to learn.

Then she and I had a time to rebut each other, and I got to go first. I agreed with her, kind of: the costs are dependent on the time, and the more a surgeon does, the better and faster they will become. Because of that, for me, it is actually cheaper for some of my patients to have scarless surgery! And I told her that it is hard to learn for sure, but MOST patients are actually eligible for scarless thyroid surgery.

She had her chance to rebut and felt like most surgeons haven't been able to master the technique, and so we need to instead focus on making scars look better. We finished with Dr Kaitlyn Frazier of Johns Hopkins and Dr Kepal Patel from NYU asking us if we would offer scarless surgery in specific situations. No surprise, but of the 4 cases presented (including Graves' disease, a goiter, an indeterminate nodule, and a cancer), each one of them was a candidate for scarless thyroid surgery for me.

So who won, Dr Parangi or Dr Russell? The patients won! Whenever docs get together to discuss the best way to treat thyroid problems, we all learn from each other. From my point of view, I was very grateful for Dr Parangi's perspective, and also happy that she was able to learn that even "challenging" cases are usually eligible for "scarless" thyroid or parathyroid surgery at the Russell Center for Endocrine Health!

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