76: Is Your Thyroid Surgeon Skilled? 4 Mistakes Resulting from Inexperience, with Dr. James Netterville from Vanderbilt

James L. Netterville, M.D.
Mark C. Smith Professor of Head and Neck Surgery, Professor of Otolaryngology
Director, Head & Neck Oncologic Surgery
Associate Director, Bill Wilkerson Center for Otolaryngology and Communication Sciences

Dr. Netterville is the Director of Head and Neck Surgery at Vanderbilt and is an international leading authority of treating head and neck cancer. He is one of the world's experts in the treatment of skull base tumors and has a vast clinical experience.

Todays topic's include:

• Reoccurrence thyroid disease patients in paratracheal, thyroid bed, and cervical lymph nodes
• Papillary thyroid cancer and subtypes: tall cell, columnar, oncocytic, clear cell, hobnail
• The extreme importance of the pathologist
• Facebook is one of the number one sources of referrals
• The changing landscape of researching physicians
• PubMed and Index Medicus have replaced the library and medical literature
• In past 5 years patients are seeking advice from peers and experiences from others
• Patients have become the bets marketers for physicians versus the institution
• performing thyroid surgery on professional singers
• Patients are attached to a doctor and care team, which is often driven by social media
• Paratracheal region, and difficulty in ultrasound
• Selective neck dissection
• The evil remnant: when a surgeon inadvertently leaves thyroid cancer behind
• Three areas where thyroid cancer reoccurs: where remnant is left behind, hidden paratracheal lymph nodes,
• Lymph nodes in levels II, III, IV
• Some surgeons' misperceptions about the effectiveness of RAI as a means to cleaning up poor surgery
• Doing a thyroid surgery is easy.  Doing it right is hard.  The importance of finding a surgeon who knows how to do it right
• Damage to RLN and leaving cancer behind or remnant, is due to inexperience
• Working around larynx and voice box during thyroid surgery
• Challenges with the trachea during thyroid surgery
• Grafting the RLN
• Grafting the RLN, in line graft, ends of motor nerves and sewing them back to the RLN
• Thyroid marketing and the term minimally invasive 
• Superior RLN protection
• Preserving the cricothyroid muscle, especially singers
• The importance of being a good listener
• Vetting a surgeon by searching social media or reputation, publications, and volume
• Is thyroid cancer a cancer or just a nuisance.  Chances are it is not going to kill you.
• Doctors managing their reputation online
• RAI and killing gross disease fallacy
• A surgeon's personal brand versus institution branding
• Online eduction

NOTES

Vanderbilt Health

Vanderbilt-Ingram Cancer Center

Thyroid research

Funding surgical educational camps in Africa

PubMed

Index Medicus

Aggressive Variants of Papillary Thyroid Carcinoma: Hobnail, Tall Cell, Columnar, and Solid

American Thyroid Association