Why Choose Parathyroid / Thyroid Surgery with Us?

3 reasons to book an endocrine surgery with James Kirkby-Bott

Continuous Nerve Monitoring

Spire Southampton in conjunction with James Kirkby-Bott are the only site in the region routinely using continuous intra-operative nerve monitoring (cIONM) during every operation. This cutting edge technology improves voice preservation and airway protection. It continually monitors nerve function and warns James of changes in wave signal that precede functional nerve damage causing altered voice and recurrent chest infections.

Fully trained in Endocrine Surgery & QI

James trained at the Hammersmith Hospital London and CHRU Lille Endocrine Surgery units. James has been a leading surgeon voice in using outcomes to improve quality QI in surgery. These are big passions. Combining them leads to the best advice and outcomes.

Real-time PTH in surgery

Coming to Spire Southampton soon..

Real-time PTH monitoring in Thyroid and Parathyroid surgery (IOPTH) is key to improving outcomes.

Using localisation studies and IOPTH can improve parathyroid surgery success from 94% (localisation only) to 99% with localisation and IOPTH.

Using IOPTH in Total thyroidectomy can predict low calciums due to little PTH hormone being available. Doing this during surgery can help our decision making to try and preserve parathyroid function long term.

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Innovation

Continuous intra-operative nerve monitoring - cIONM

The recurrent laryngeal nerve (RLN) is at risk on each side of the trachea that the Thyroid gland and parathyroid glands are draped over. The nerves supply the vocal fold (we have one each side). If damaged the vocal fold will not move normally. It can remain either open or closed or somewhere in-between. This weakens the strength and refinement of your voice. The voice box works harder to make you heard and so tires more quickly than it should so you can lose your voice during the day. It also protects the airways from food, secretions and fluids. If these get into the airway, they can make you cough and splutter. It is called aspiration and leads to recurrent chest infections an altered swallow sensation.

So being able to monitor the function of the RLN during surgery seems like a good idea! nerve monitoring started to be introduced around 2008 in thyroid surgery, but its uptake has been slow in the NHS due to the additional expense of the machine and consumables used with each case. There was not enough evidence to prove its efficacy and the technology was in early stages of development.

Fast forward to today. The technology has advanced to the point that we can see the wave signal of the RLN throughout the operation and note if it changes, beat to beat. This wave signal changes long before the function of the nerve is lost. Because we now better understand how the signal change is warning us of possible ensuing loss of function, we can change what we are doing before the wave signal changes become a loss of function. It has become so reliable that we no longer need to routinely check for vocal cord function before and after surgery.

We used to do this by putting a flexible camera all the way up the nose and around and down into the back of the throat to examine the cords. In my practice we no longer need to do this unless during surgery there is a serious and persistent change in RLN function and change of voice.

Recurrent Chest infection from RLN damage

This fact was little known about until a few years ago. If you permanently lost the function of the RLN you can get recurrent chest infections. People with a RLN palsy from any cause had an average reduction in their life span of 10 years because of this injury due to chronic chest disease. cIONM can prevent this.

Reducing RLN injury

In the past temporary loss of RLN function after this kind of surgery was around 12-15%. It was permanent in 1-3%. Observational outcome data now shows that cIONM significantly reduces RLN palsy compared to using no nerve monitoring or even intermittent nerve monitoring. With cIONM it is falling further and with time and embracing innovative technology we hope to make this surgical complication a thing of the past.

Voice change

There is a second nerve often damaged in thyroid surgery called the external branch of the superior laryngeal nerve. It is tiny. The cIONM can be used to monitor and help us find this nerve too. The impact of damage to this nerve only ever really impacted singers. But sparing it is still a bonus and loss of minor voice refinement will improve as a result in all patients.