Surgical training program of parathyroidectomy for residents in a national center: a cohort of 122 cases.

BACKGROUND

Primary hyperparathyroidism (PHPT) is a relatively uncommon endocrine disorder in China. As the national referral center for parathyroid diseases, Peking Union Medical College Hospital (PUMCH) has abundant clinical resources to make parathyroidectomy a valuable surgical procedure for resident training.

OBJECTIVE

After completing the training program, residents become proficient in diagnosis and perioperative care, and can perform simple cases under the supervision of senior surgeons.

METHODS

PHPT diagnosis and tumor localization were performed by a multidisciplinary team. Residents were enrolled in a surgical training program under the guidance of experienced senior surgeons. Intraoperative recurrent laryngeal nerve monitoring (IONM) and intraoperative parathyroid detector (IOPD) were employed. Upon completing the training, an online questionnaire was administered to residents to collect feedback on their experience.

RESULTS

122 parathyroidectomies were performed, with 60 residents trained. The mean age was 53.2 ± 13.8 years, and 71.3 % (87 cases) were female. The mean tumor size was 20.6 ± 10.9 mm, and the mean operative time was 73.2±28.6 minutes. No iatrogenic intraoperative injuries or major complications occurred. Serum parathyroid hormone (PTH) declined below the upper limit value (ULV) in 109 cases (89.3 %), and serum calcium declined below the ULV in 110 cases (90.2 %). Only 4 cases (3.3 %) exhibited both PTH and calcium levels above the ULV on postoperative day 1. Within 3 months of follow-up, no surgical complication occurred. Among the 55 residents who responded to the questionnaire (91.7 %), all reported satisfaction with the training. Specifically, 89.1 % felt more confident in acting as chief surgeon, and 94.5 % acknowledged the training's helpfulness for their future careers. Regarding essential technologies, 69.1 % emphasized IONM, while 41.8 % highlighted IOPD. The most frequent suggestions for program improvement were to provide more opportunities and further difficulty-stratified training.

CONCLUSION

In a high-volume center, a parathyroidectomy surgical training program proves feasible and beneficial for residents to master surgical treatment of this rare disease.