Supervised surgical trainees can perform pancreatic resections safely

With the recent changes in surgical training and sub-specialisation, the role of surgical trainees in more advanced surgical procedures has come into question. In order to examine this further, we analysed the early outcome of patients in a single surgical unit undergoing pancreatic resections, with regard to the grade of the surgeon performing the operation. Between January 1994 and May 1996, data were collected prospectively on all the patients undergoing pancreatic resections with regards to the grade of the surgeon performing the procedure and the early outcome following the operation. Sixty-two patients underwent pancreatic resections for both benign and malignant diseases. Overall, 19 operations (31%) were performed by trainees under supervision, 14 of the 40 pancreatico-duodenectomies (35%) and 5 of the 19 left partial pancreatectomies (26%). All 3 total pancreatectomies were carried out by consultants. In the 43 patients operated upon by the consultants, there were 8 anastomotic leaks (19%) and 1 death. In the 19 patients operated upon by the supervised trainees, there were only 2 anastomotic leaks (11%) and no deaths. This series has demonstrated that in a unit with a major interest and large workload in pancreatic surgery, there appears to be no difference between a consultant and a supervised trainee in the early outcome following pancreatic resections.     

Outcome in patients with colorectal cancer managed by surgical trainees.

BACKGROUND: The surgeon is an important variable that influences outcome following colorectal cancer surgery. Operative training of suitable quality and quantity is essential if intersurgeon variation is to be reduced. The aim of this study was to examine the outcome of colorectal cancer surgery when a high proportion of the operations were performed by trainee surgeons. METHODS: A prospective 7-year (1989-1996) audit of 306 consecutive colorectal cancers referred to a single general surgeon with a colorectal interest was carried out. The outcome (anastomotic leakage, 30-day mortality rate, local recurrence and cancer-related survival) of operations performed by the consultant was compared with that of his trainees. RESULTS: Some 245 (92.5 per cent) of 265 patients undergoing laparotomy had a resection. Seventy (28.6 per cent) and 67 (27.3 per cent) of operations were performed by supervised and independent trainees respectively. There was no difference between the consultant, supervised and independent trainees for 30-day mortality rate (6.5, 6 and 4 per cent respectively), clinical anastomotic leakage rate (9, 2 and 5 per cent) and local recurrence rate (2, 3 and 7 per cent). There was no difference between the three groups for adjusted 5-year disease-related survival rates. CONCLUSION: Properly supervised trainees can resect a high proportion of colorectal cancers without compromising immediate outcome or long-term survival. Presented in part to the annual meeting of the Association of Surgeons of Great Britain and Ireland, Bournemouth, UK, April 1997, and published in abstract form as Br J Surg 1997; 84(Suppl): 56     

Role of the surgical trainee in upper gastrointestinal resectional surgery.

The 'New Deal' set out by the Department of Health in 1991, together with the introduction of specialist 6-year training grades by Calman in 1993, has resulted in a decrease in available training time for surgeons in the UK. There is also an emerging belief that surgical procedures performed by trainees might compromise patient outcome. This study examines the level of trainee experience in a specialist gastrointestinal unit and whether operation by a trainee surgeon adversely affects patient outcome. All patients in the University Department of Surgery, Royal Infirmary, Edinburgh, undergoing oesophagogastric, hepatic or pancreatic resection between January 1994 and December 1996 were entered into the study. The early clinical outcome (in-hospital mortality and morbidity, considered in three groups: anastomotic leak, other technique-related complications and non-technique-related complications) was evaluated with regard to the grade of surgeon (consultant or trainee) performing the operation. Of the 222 patients undergoing major upper gastrointestinal resection during the study period, 100 (45%) were operated on by trainees. Trainees were assisted and closely supervised by consultants in all but six resections. There was no major difference in mortality rate (consultant, 4.1% vs trainee, 5%), incidence of non-technique-related complications (consultant, 6.7% vs trainee, 7.1%), anastomotic leaks (consultant, 10.7% vs trainee, 5%) or technique-related complications (consultant, 18.9% vs trainee, 15%) between the two grades of surgeon. In a specialist unit, the early clinical outcome of patients undergoing major upper gastrointestinal resection by supervised trainees is no worse than in those operated on by consultants. Participation of trainees in such complex procedures enhances surgical training and does not jeopardise patient care.     

Effects of training and supervision on recurrence rate after inguinal hernia repair

BACKGROUND: There is little information about the effects of operative experience and supervision of trainees on outcome in inguinal hernia surgery, one of the cornerstone operations of basic surgical training. METHODS: All primary inguinal hernia repairs carried out between 1994 and 2001 were registered prospectively in the Lothian Surgical Audit database. Subsequent problems that required re-referral were identified from this database. Patients who required reoperation for recurrence a median of 3 (range 1-7) years after surgery were identified. RESULTS: Some 4406 repairs, including 90 recurrences (2.0 per cent), were identified. Open mesh, open sutured and laparoscopic techniques were employed. Senior trainees (registrars and senior registrars) had similar recurrence rates to consultants; supervision did not affect outcome. Junior trainees (senior house officers) had similar recurrence rates to consultants as long as they were supervised by either a senior trainee or a consultant. Unsupervised junior trainees had unacceptably high recurrence rates (open mesh: relative risk (RR) 21.0 (95 per cent confidence interval (c.i.) 7.3 to 59.9), P < 0.001; open sutured: RR 16.5 (95 per cent c.i. 7.2 to 37.8), P < 0.001). CONCLUSION: Senior trainees may operate independently and supervise junior trainees, with recurrence rates equal to those of consultant surgeons. Junior trainees should be encouraged and given more practice in inguinal hernia repair with appropriate supervision.     

Effect of operating surgeon on outcome of arteriovenous fistula formation.

OBJECTIVE: To study whether surgical trainees can perform arteriovenous fistula (AVF) surgery to a standard comparable to consultants. PATIENTS AND METHODS: Retrospective study of all vascular access surgery over a three year period at a single centre. The operating surgeon was identified from theatre log books and categorised by grade. Fistula patency was used as the primary outcome measure and was determined from patients' case-notes and from a prospectively collected electronic record of dialysis sessions. Patency was defined as "used for dialysis" if the AVF was used for dialysis for at least 6 consecutive sessions. RESULTS: One hundred and eighty six cases were used for analysis. In 60 cases (32%) the operating surgeon was the consultant, in 53 cases (29%) a trainee was supervised by a consultant, in 56 cases (30%) a trainee performed the operation independently and in 17 cases (9%) the grade of the operating surgeon could not be established. Primary and primary assisted patency rates by operating surgeon did not differ significantly (P-values 0.25 and 0.16 respectively). Age of the patient was the only predictor of patency failure in a multivariate model. Grade of operating surgeon (logrank test chi(2)=3.1, p=0.38) and type of fistula (logrank test chi(2)=2.3, p=0.52) were not significantly related to the primary survival of the fistula. CONCLUSIONS: This study showed no significant differences in AVF patency rates between trainee and consultant surgeons. Allocation of appropriate cases can result in trainees obtaining similar outcomes as consultants, demonstrating that dialysis access surgery can provide good training opportunities for junior doctors without detriment to patient care.     

The impact of training on outcomes in primary vascular access surgery

BACKGROUND: There is evidence that the outcome of arteriovenous fistula surgery is dependent on the surgeon performing the operation. Vascular access surgery provides excellent technical training for surgical trainees. The effect of surgical trainees on the outcome of fistulas was evaluated. METHODS: The grade of the main operator for all first attempted (primary) upper limb arteriovenous fistulas, between February 1998 and August 2001, was identified. Median follow-up was 18.0 months (IQR, 6.5-30.1 months). Successful use of fistula for dialysis, fistula patency and survival were assessed. RESULTS: 441 primary fistulas were formed in the study period. Median age was 67.5 years (IQR, 54.0-75.2 years). 71% of all fistulas were formed at the wrist. Trainees performed 31.1% of all operations. The two groups (trainees and consultants) were well matched for age, sex, diabetes, and fistula type. Only 70.5% of patients proceeded to long-term haemodialysis. There were no significant differences in the successful use of AVF for dialysis or patency rates between the two groups. One and two year fistula survival in this group was 87.7% and 78.3% for trainees and 80.8% and 71.1% for consultants (P = 0.288 log rank). CONCLUSIONS: Surgical trainees can perform primary AVF surgery without significantly reducing fistula outcomes. Vascular access surgery can be utilised as a training operation.     

Elective and emergency surgery for colorectal cancer in a district general hospital: impact of surgical training on patient survival

A total of 640 patients were studied retrospectively after surgery for colorectal cancer over a 5-year period at a district general hospital. The complications, perioperative survival figures, and 5-year survival figures were recorded with particular reference to the grade of surgeon carrying out the original operation. The number and type of complications were similar for consultants and for surgeons-in-training with the exception of operative injury to the ureters and postoperative anastomotic strictures, which were more common in cases operated on by consultants. Perioperative mortality rates were similar after elective and emergency operations, but emergency surgery was associated with a significant increase in mortality when compared with elective surgery if the operation was undertaken by a trainee. Although the 5-year survival rate rose when a consultant surgeon carried out the original operation, the difference was not significant.     

Adult living donor liver transplantation: Perspectives from 100 liver transplant surgeons

The involvement of healthy living donors and the degree of technical difficulty make adult living donor liver transplantation (LDLT) different from any other surgical procedure. We surveyed 100 liver transplant surgeons to assess their views on the complex issues raised by LDLT. Data were collected at meetings on LDLT and by electronic mail. The study instrument was divided into general, donor, surgeon, recipient, and donor and recipient issues. Subjects provided the projected 1-year survival threshold that they would require for the recipient before they would perform LDLT. They listed the three topics that they thought were most critical for transplant fellows to know about LDLT. A majority agreed that transplant programs have a duty to their patients to offer LDLT, that the increasing success of the procedure will expand indications for liver transplantation, and that the risk to the donor causes them a moral dilemma. There was more divergence of opinion regarding who should have the final say about a potential donor's candidacy, whether it is difficult for donors to comprehend the risks of the procedure, and whether repeat cadaveric transplantations should be offered for failed LDLT performed for extended indications. Surgeons' median recipient survival threshold was a conservative 79%. Priorities for educating trainees focused on understanding complications and risks, technical factors, and ethical concerns such as putting the donor first. In conclusion, the findings of this survey indicate that transplant surgeons are working to balance their moral imperative to provide life-saving therapy for transplantation candidates with the risks posed to living donors. (Liver Transpl 2003;9:637-644.)     

Do supervised colorectal trainees differ from consultants in terms of quality of TME surgery?

OBJECTIVE: The quality of surgical excision is held to be a major determinant of outcome following surgery for rectal cancer. Macroscopic examination of the excised mesorectum allows for reproducible assessment of the quality of surgery. We aimed to determine whether quality of excision undertaken by colorectal trainees under supervision was comparable with that performed by consultants, as measured using mesorectal grades. METHOD: A total of 130 consecutive patients undergoing potentially curative resection for primary adenocarcinoma of the rectum in our centre from 2001 to 2003 were included in the study. The pathologists graded the excised mesorectum according to staged classification proposed by Quirke. The outcome (quality of mesorectal excision and secondary outcomes including local recurrence and overall recurrence) of operations performed by consultants was compared with that of trainees. Statistical significance was tested using Pearson chi(2) test. RESULTS: Eighty-nine operations were performed by consultants and 41 by senior colorectal trainees with consultant supervision. Forty-four patients (49%) had good mesorectum when operated by consultants in comparison with 17 (41.5%) by the trainees. There was no statistically significant difference (P = 0.717) between the two groups in terms of quality of mesorectum excised after potentially curative resection. Furthermore, there were seven local recurrences in patients operated by consultants (7.8%) when compared with four in the trainee group (9.5%) and once again there was no statistical significance between the two groups (P = 0.719). CONCLUSION: We conclude that the quality of rectal cancer excision, as defined by mesorectal grades, achieved by supervised colorectal trainees is comparable with that achieved by consultants.     

Effect of supervised surgical training on outcomes after resection of colorectal cancer

BACKGROUND: The process of training surgeons in technique for resection of colorectal cancer should not compromise patient care or outcomes. The aim of this study was to compare morbidity, mortality and survival rates after resection performed by trainees with those for a consultant surgeon. METHODS: Outcomes for 150 patients operated on by a single colorectal surgeon at a private hospital were compared with those of 344 patients admitted under the same surgeon and operated on by closely supervised trainee surgeons in a public teaching hospital between 1995 and 2002. RESULTS: Co-morbidity was significantly more common in patients operated on by trainees; their American Society of Anesthesiologists grades were higher and tumours were more advanced. Of 16 postoperative complications evaluated, only respiratory and cardiac problems were significantly more common in patients operated on by trainees. There was no difference in operative mortality, local recurrence or 2-year survival rate after adjustment for age and tumour stage. CONCLUSION: Outcomes after resection for colorectal cancer did not differ between the consultant and trainees in the context of a closely supervised training programme.     

Involvement of surgical trainees in surgery for colorectal cancer and their effect on outcome

Objective Surgical training in the UK is undergoing substantial changes. This study assessed: 1) the training opportunities available to trainees in operations for colorectal cancer, 2) the effect of colorectal specialization on training, and 3) the effect of consultant supervision on anastomotic complications, postoperative stay, operative mortality and 5‐year survival. Method Unadjusted and adjusted comparisons of outcomes were made for unsupervised trainees, supervised trainees and consultants as the primary surgeon in 7411 operated patients included in the Northern Region Colorectal Cancer Audit between 1998 and 2002. Results Surgery was performed in 656 (8.8%) patients by unsupervised trainees and in 1578 (21.3%) patients by supervised trainees. Unsupervised operations reduced from 182 (12.4%) in 1998 to 82 (6.1%) in 2002 (P < 0.001). Consultants with a colorectal specialist interest were more likely than nonspecialists to be present at surgical resections (OR 1.35, 1.12–1.63, P = 0.001) and to provide supervised training (OR 1.34, 1.17–1.53, P < 0.001). Patients operated on by unsupervised trainees were more often high‐risk patients, however, consultant presence was not significantly associated with operative mortality (OR 0.83, 0.63–1.09, P = 0.186) or survival (HR 1.02, 0.92–1.13, P = 0.735) in risk‐adjusted analysis. Supervised trainees had a case‐mix similar to consultants, with shorter length of hospital stay (11.4 vs 12.4 days, P < 0.001), but similar mortality (OR 0.90, 0.71–1.16, 0.418) and survival (HR 0.96, 0.89–1.05, P = 0.378). Conclusion One third of patients were operated on by trainees, who were more likely to perform supervised resections in colorectal teams. There was no difference in anastomotic leaks rates, operative mortality or survival between unsupervised trainees, supervised trainees and consultants when case‐mix adjustment was applied. This study would suggest that there is considerable underused training capacity available.     

Prospective randomized trial of end-to-end versus side-to-side biliary reconstruction after orthotopic liver transplantation

BACKGROUND: Biliary reconstruction is the Achilles heel of liver transplantation. Side-to-side anastomosis of donor and recipient bile duct has been claimed to be superior to end-to-end anastomosis in uncontrolled studies. Methods: A total of 100 consecutive patients undergoing orthotopic liver transplantation were randomized after commencement of the transplant procedure to end-to-end or side-to-side anastomosis. No T tube drainage was employed. Endoscopic retrograde cholangiography was performed 2 weeks after transplantation and findings were reported by an experienced endoscopist as normal, leak or stricture. Median follow-up was 53 (range 35-63) months. RESULTS: Patient age, sex, the graft preservation time and indication for transplantation were similar in both groups. Sixty patients received end-to-end and 40 side-to-side anastomosis. Ten patients randomized to side-to-side anastomosis had an end-to-end procedure. The total number of biliary complications was similar in both groups (end-to-end 32 per cent versus side-to-side 30 per cent) as were the number of leaks (17 versus 18 per cent) and biliary strictures (15 versus 12 per cent). There was no difference in the number of biliary complications that required interventional treatment (22 per cent in both groups). CONCLUSION: Side-to-side and end-to-end biliary anastomosis at liver transplantation are equally effective.     

保留下腔静脉的离体低温右肝扩大切除治疗不可切除IV型肝门部胆管癌

目的:探讨保留下腔静脉的离体低温肝切除治疗不可切除Ⅳ型肝门部胆管癌的效果.方法:回顾性分析2例Ⅳ型肝门部胆管癌患者临床资料,其中1例行保留下腔静脉的原位低温灌注扩大右肝切除术,另1例采用保留下腔静脉的全离体扩大右肝切除治疗.结果:原位低温灌注扩大右肝切除术历时14h,术中输血3 000 mL,然而,患者术后第1天死于多器官功能衰竭.全离体扩大右肝切除术历时15h,术中输血2 000 mL,热缺血时间20 min,冷缺血时间195 min,术后30d出院,无肝衰和其他重大并发症发生,随访11个月,患者仍然存活且无血管、胆管并发症及肿瘤复发和转移.结论:在有复杂肝切除经验和活体肝移植经验的前体下,保留下腔静脉的离体低温肝切除是安全的,且可能是治疗精选的不可切除Ⅳ型肝门部胆管癌的有效选择.     

Effect of early transplant function as an index of recipient presensitization on long-term function of machine-preserved cadaveric kidneys

The early post-transplantation function of machine-preserved cadaveric kidneys judged to be of good quality from perfusion data appeared to provide a good in vivo clinical index of recipient presensitization to donor transplant antigens. The quality of early function was affected adversely by prolonged pretransplantation hemodialysis, by multiple transplants (second and third), and by the identified presence of antibody-against-the-panel (AbAP) values of 10 per cent or more. The highest pretransplantation AbAP per cent and the per cent nearest the time of transplantation also were factors in the quality of early transplant function (F, F^AR, SF, or NF class early transplant function).The level or “titer” of recipient presensitization appeared to have an effect on long-term transplant survival and the level of function of these kidneys. Long-term (one year) function of cadaveric kidneys in nonsensitized recipients or those with a low titer of sensitization (F class) was 51 per cent. That for recipients with intermediate titers of sensitization (F^AR and SF classes) was 29 per cent and 61 per cent, respectively. Long-term transplant survival for recipients with a presumed high titer of presensitization (NF class) was 40 per cent. The long-term survival of SF class kidneys at risk to the immune response was 79 per cent. That for F^AR and NF class kidneys that recovered function after the initial presumed immunologic assault was 89 and 88 per cent, respectively.Long-term transplant function in “nonsensitized” recipients (F class) was not influenced significantly by the number of HL-A antigens mismatched donor-to-recipient (0, 1, 2, 3, or 4). The long-term transplant survival in a small group (eight patients) of nonsensitized (F class) recipients subjected to splenectomy because of anemia and leukopenia prior to transplantation was 88 per cent, and that for “nonsensitized” (F class) recipients not undergoing splenectomy at the same transplantation center was 44 per cent.     

“Happy to close?” The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery

Aim

Incisional hernia (IH) is a common complication of colorectal surgery, affecting up to 30% of patients at 2 years. Given the associated morbidity and high recurrence rates after attempted repair of IH, emphasis should be placed on prevention. There is an association between surgeon volume and outcomes in hernia surgery, yet there is little evidence regarding impact of the seniority of the surgeon performing abdominal wall closure on IH rate. The aim of our study was to assess the rates of IH at 1 year following abdominal wall closure between junior and senior surgeons in patients undergoing elective colorectal surgery.

Methods

This was an exploratory analysis of patients who underwent elective surgery for colorectal cancer between 2014–2018 as part of the Hughes Abdominal Repair Trial (HART), a prospective, multicentre randomised control trial comparing abdominal wall closure methods. Grade of surgeon performing abdominal closure was categorised into “trainee” and “consultant” and compared to IH rate at one year.

Results

A total of 663 patients were included in this retrospective analysis of patients in the HART trial. The rate of IH in patients closed by trainees was 20%, compared to 12% in those closed by consultants (p = <0.001). When comparing closure methods, IH rates were significantly higher in the Hughes closure arm between trainees and consultants (20% vs. 12%, p = 0.032), but not high enough in the mass closure arm to reach statistical significance (21% vs. 13%, p = 0.058). On multivariate analysis, age (p = 0.036, OR: 1.02, 95% CI: 1.00–1.04), Male sex (p = 0.049, OR: 1.61, 95% CI: 1.00–2.59) and closure by a trainee (p = 0.006, OR: 1.85, 95% CI: 1.20–2.85) were identified as risk factors for developing IH.

Conclusion

Patients who undergo abdominal wall closure by a surgeon in training have an increased risk of developing IH when compared to those closed by a consultant. Further work is needed to determine the impact of supervised and unsupervised trainees on IH rates, but abdominal wall closure should be regarded as a training opportunity in its own right.     

Training in infrainguinal bypass surgery for severe leg ischaemia

BACKGROUND: Recent changes in surgical training in the UK mean that operative experience must be gained more efficiently. However, it is important to demonstrate that improved training opportunities are not associated with inferior patient outcomes. The aim was to examine changes in training in infrainguinal bypass surgery and to compare the outcomes of operations performed by consultants and trainees. METHODS: A prospectively gathered, computerized database of 1077 consecutive infrainguinal bypasses performed on 1003 patients for chronic severe leg ischaemia between 1 January 1983 and 31 December 1998 was analysed. RESULTS: Consultants performed 733 (68 per cent) infrainguinal bypasses to the following distal sites: 347 (47 per cent) above-knee popliteal artery, 257 (35 per cent) below-knee popliteal artery, 121 (17 per cent) to a crural artery and eight (1 per cent) other. Trainees performed 344 operations: 170 (49 per cent) were to the above-knee popliteal artery, 122 (35 per cent) to the below-knee popliteal artery, 48 (14 per cent) crural and four (1 per cent) other. The operative mortality rate was 27 (4 per cent) of 733 for consultants and 11 (3 per cent) of 344 for trainees (P > 0.05, chi2 test). There were no significant differences in patency or limb salvage at 36 months after operation between consultants and trainees, regardless of the site of distal anastomosis and the type of conduit used. CONCLUSION: With appropriate case selection and supervision, training in infrainguinal bypass grafting does not compromise early or long-term patient outcomes.     

Effect of training on patient outcomes following lobectomy

BACKGROUND: Little is known about the effect of surgical training on outcomes in thoracic surgery. The impact of surgeon training on outcomes following lung resection was examined, focusing on lobectomy as a marker operation. METHODS: 328 consecutive patients who underwent lobectomy at our institution between 1 October 2001 and 30 June 2003 were studied. Data were collected prospectively during the patient's admission as part of routine clinical practice and validated by a designated audit officer. Patient characteristics and postoperative outcomes were compared between trainee led and consultant led operations. RESULTS: In 115 cases (35.1%) the operation was performed by a trainee thoracic surgeon as the first operator. There were no significant differences in patient characteristics between the two groups. In-hospital mortality was similar for operations led by trainees and consultants (3.5% and 2.8%, respectively; p > 0.99). Outcomes in the two groups did not differ significantly with respect to respiratory, cardiovascular, renal, neurological, chest infection, bleeding, and gastrointestinal complications. Survival rates at 1 year were 82.6% for procedures led by trainees compared with 81.7% for procedures led by consultants (p = 0.83). CONCLUSIONS: With appropriate supervision, trainee thoracic surgeons can perform lobectomies safely without compromising short or intermediate term patient outcome.     

Orthotopic partial hepatic transplantation in dog

Based on the simple anatomy that the venous blood from the left half of the liver is drained by the single left hepatic vein in the dog, the left half of the donor liver was transplanted orthotopically in the space after left hepatic lobectomy of the recipient. Since this technique does not require complete occlusion of either the caval vein or the portal vein, external shunts are unnecessary. Furthermore there is no anhepatic phase during the transplantation procedure and consequently the surgical invasion to the recipient is minimal. Partial liver transplantation using the technique described has thus many advantages. Of the animals transplanted one survived 39 days after the orthotopic partial hepatic transplantation with 70 per cent hepatectomy of the recipient, and the other survived 10 days after total hepatectomy.     

Polycystic Liver Disease and Liver Transplantation: Single-Institution Experience

Adult polycystic liver disease (PLD) can cause massive hepatomegaly leading to pain, caval obstruction, and hemorrhage. Many surgical techniques including aspiration, fenestration, and resection have been used to treat PLD. In addition to substantial morbidity and mortality, conservative surgery may have limited success, and palliation may be temporary. With improved results of liver transplantation, it has become the definitive treatment for PLD. We retrospectively reviewed our experience in patients with PLD between 1998 and 2007. Thirteen patients underwent liver only or liver-kidney transplantation. All surgical procedures were performed with preservation of the recipient inferior vena cava and without venovenous bypass (piggyback technique). Our patients experienced a high rate of perioperative morbidity. However, long-term patient and graft survival were excellent.     

Supervised surgical trainees perform thyroid surgery for Graves’ disease safely

Background There is little information about the effect of operative experience and supervision of trainees on long-term outcomes after thyroid resection for Graves’ disease (GD). The aim of this study was to compare the morbidity rate after thyroid resection performed by trainees vs consultant surgeons.Methods Based on a cross-sectional design analysis with a median follow-up of 96 months (range, 12–216 months), long-term outcomes for 111 patients operated on by consultants were compared with those of 42 patients operated on by supervised trainees in an academic teaching hospital between 1987 and 2002.Results Of the 111 patients operated on by the consultants, there were 25 (21.6%) cases of transient and 12 (10.8%) cases of permanent hypocalcemia and 10 (9.0%) cases of transient and 1 (0.9%) case of permanent recurrent laryngeal nerve (RLN) palsy. Of the 42 patients operated upon by the supervised trainees, there were 8 (21.4%) cases of transient and no permanent hypocalcemia, 3 (7.1%) cases of transient, and 1 (2.3%) case of permanent RLN palsy. Permanent complication rate of the entire group was low, and the grade of the primary surgeon made no difference in the occurrence of complications (P>0.05).Conclusion Supervised trainees can perform thyroid surgery for GD safely if a standardized surgical teaching program is available.