In early 2013, Barry Goldlist 61, a dentist from Thornhill, Ontario, thought he was battling a typical winter cold or flu. After finding a lump on the side of his throat, he went to his family physician for medical advice.
Blood work and an ultrasound confirmed a growth on his thyroid that would require removal (thyroidectomy). Thyroidectomy is used to treat thyroid disorders, such as cancer, noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).Partial thyroid surgery (or partial thyroidectomy) is when only part of the thyroid is removed and the thyroid can still function on its own, without thyroid hormone replacement.
When referred to Dr. Philip Solomon, Chief of Surgery at Mackenzie Health, Dr. Goldlist learned that the surgery could be completed on an outpatient basis.
“I was very comfortable proceeding, knowing that only if something unexpected happened I would require an inpatient stay,” says Dr. Goldlist. “Everything was explained to me and I fully understood all the possibilities, but was still very comfortable. There were no surprises and everyone knew what they were doing, even with this being a ‘newer’ technique. In my opinion, when your patients fully understand you, that’s three-quarters of the battle.”
Traditionally, thyroid surgery requires an inpatient stay. Since introducing this new procedure, Dr. Solomon has performed approximately 200 thyroid surgeries for goiters and thyroid cancer on an outpatient basis at Mackenzie Health.
Confident of the safety of providing this surgery on an outpatient basis, in June 2011, Dr. Solomon, co-authored an article in the Journal of Otolaryngology, Head & Neck Surgery, which found that outpatient thyroid surgery is not only safe and effective, but could significantly benefit the healthcare system.
As one of only a handful of Canadian hospitals currently using this technique, Mackenzie Health is the first community hospital to have a peer reviewed journal article published on this use of this new technology.
All thyroid surgeries, both partial and full performed by Dr. Solomon, are now planned as an outpatient procedure, using the HARMONIC® Focus developed by Johnson & Johnson. This scalpel, enabled with ultrasound technology, allows surgeons to detach the thyroid, seals the wound and prevents bleeding post-operatively.
The paper’s senior author noted that the HARMONIC® Focus “may reduce operating time and provides excellent hemostasis” (the process which causes bleeding to stop and is the first step in wound healing).
“The ability to perform partial thyroid surgeries on an outpatient basis is of particular importance for community hospitals like Mackenzie Health,” says Dr. Solomon. “As healthcare resources become tighter and wait times increase, there is a need to challenge some of our conventional practices in an effort to provide greater access to care for patients in our community.”