PRECISION TRAINING IN ENDOCRINE SURGERY: A PREOPERATIVE NOMOGRAM TO GUIDE CASE ALLOCATION AND PREDICT THYROIDECTOMY DIFFICULTY surgeonspirit@gmail.com

362-05

PRECISION TRAINING IN ENDOCRINE SURGERY: A PREOPERATIVE NOMOGRAM TO GUIDE CASE ALLOCATION AND PREDICT THYROIDECTOMY DIFFICULTY

5

 

 

 

 

India

Oral or Poster

Balancing trainee autonomy with patient safety remains a challenge in surgical education. Thyroidectomy, while commonly performed, can present varying degrees of technical difficulty. Unanticipated complexity during surgery may compromise outcomes or necessitate unplanned senior intervention. A preoperative tool to predict and stratify difficulty can enhance both patient care and structured training.

A prospective study was conducted on 200 thyroidectomy cases (112 hemithyroidectomies, 88 total) at a tertiary academic center. Surgeries were performed by consultants (n=128) and trainees (n=72). Difficult thyroidectomy was defined using standardized criteria based on intraoperative complexity and need for senior assistance. Preoperative variables—clinical, anatomical, and imaging features—were analyzed by multivariate logistic regression. A point-based nomogram was constructed, and patients were stratified into low (score <4), intermediate (4–6), and high-risk groups (>6). Subgroup analysis compared risk levels with operator experience.

Fifty-two cases (26%) were classified as difficult, with 92% requiring consultant takeover. Significant predictors included compressive symptoms >3 months, neck circumference ≥25 cm (OR 3.45), Mallampati III–IV (OR 2.88), TIRADS ≥4 (OR 3.72), gland size >6 cm, retrosternal extension, suspected malignancy, and high elastography stiffness. The nomogram showed good performance (C-statistic = 0.81; Hosmer - Lemeshow test p=0.52).

This nomogram offers a reproducible, preoperative framework for predicting thyroidectomy difficulty, allowing safer trainee case assignment and fostering competency-based progression in surgical training.