Der intraoperative Schnellschnitt in der Strumachirurgie

Hermann, Michael; Keminger, K; Hollinsky, C; Kober, F.

doi:10.1007/bf02659199

Cited by 4 publications

(4 citation statements)

References 5 publications

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“…Table 8 shows the investigated risk factors for postoperative recurrent laryngeal nerve paralysis and hypocalcemia: Functional autonomy is no risk-factor at all. Conventional risk-factors like size of goiter, retrostemall intrathoracic extension, extension of the operative reduction (Hermann et al, 1991) don't harbour an increased risk of permanent complications, as does not parathyroid autotransplantation. Decisive with respect to a low rate of permanent complications are the visualization of the nerve and of the parathyroid glands.…”

Section: Complicationsmentioning

confidence: 99%

Differentiated operative therapy of thyroid autonomy (Plummer's disease)

Wahl

Rimpl²,

Saalabian³

et al. 2009

Exp Clin Endocrinol Diabetes

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The operative therapy of the autonomous thyroid deals almost exclusively with nodular goiters. There are only rare situations with purely diffuse autonomy in surgical patients. The endpoint of operative therapy is permanent elimination of clinically relevant autonomous function and thereby irreversible abolition of thyrotoxicosis, even in their latent form. Clinically relevant autonomous function normally ist linked to nodular structures of different size and different distribution, so that this aim corresponds automatically with the aim of complete removal of nodular structures, both in autonomous and in non-autonomous goiters. Function is best preserved by leaving a homogenous remnant of considerable size. In different particular clinical situations (for example pregnancy, suspicion of malignancy, recurrent goiter, intrathoracic goiter, thyrotoxic crisis, Marine-Lenhart-syndrome) the basic principal of operative strategy is varied according to the respective situations. Unsatisfactory operative results are mainly caused by incomplete removal of nodules, based on insufficient surgical performance of morphological and functional diagnostics, which is related to operative uniformity. An operative strategy, which ist "fitted to morphology" and "regarding function" and which we call "selective strategy", in our opinion ist highly appropriate, to avoid remnant nodules and remnant autonomy and to preserve an normal remnant, even in different position and of different size. This selective surgery ist applicable both to autonomous and non-autonomous goiter. Compared with the classic subtotal, uniform procedure the incidence of remnant nodules is reduced from about 50% to about 5 %. Remnant autonomy is almost excluded, when mistakes are avoided (about 1%). The incidence of recurrent goiter and recurrent thyrotoxicosis is lowered to under 5%--but up to now there are too few reliable long-term follow-up studies. The selective surgery strategy demands flexibility regarding operative tactics, which can be simply classified into 5 basic situations, which we relate to the operative procedure per thyroid lobe. It requires experience and competence in carefully dissecting and--when necessary--manipulating the recurrent laryngeal nerve und the parathyroid glands. Under these conditions it is followed by a comparatively low rate of complications (permanent recurrent laryngeal nerve paralysis and hypoparathyroidism under 1%, respectively). Thus, the old dilemma of thyroid surgery can be solved, which consists of radical operation with higher morbidity and lower frequency of recurrent disease on the one hand and more limited operative procedures with fewer complications but more frequent recurrencies on the other hand.

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Section: Complicationsmentioning

confidence: 99%

Differentiated operative therapy of thyroid autonomy (Plummer's disease)

Wahl

Rimpl²,

Saalabian³

et al. 2009

Exp Clin Endocrinol Diabetes

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“…in Kombination mit anderen vorbestehenden funktionellen Defiziten (Rekurrensparese der Gegenseite) ist diese Stimulationsmöglichkeit besonders hilfreich, denn die Darstellung der paratrachealen Region bzw. des Schilddrüsenhilus kann aus den unterschiedlichsten Gründen erheblich erschwert sein[9]. Die sichere Identifikation des N. recurrens ist unter derartigen Bedingungen auch mit leistungsfähigen Operationsmikroskopen nicht…”

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Intraoperatives neurophysiologisches Monitoring (IONM) des Nervus recurrens und Mikrodissektion - Operationstechnische Verfahren zur Risikominderung von Recurrensparesen -

Hj¹

2000

Laryngorhinootologie

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“…These data were found in a randomized prospective study (not published) of 300 patients with 558 nerves at risk. In the literature, the rate of postoperative nerve palsy is described as ranging from 1% to 6% [1,2,3,4].…”

Section: Resultsmentioning

confidence: 99%

“…The method described above forces the surgeon to precisely identify the recurrent nerve. Furthermore, the technique offers the advantage of a final test of the recurrent nerve (an EMG print), which can serve as documentation should any nerve lesions occur later, as can occur during subsequent scar formation [1].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative electromyogram monitoring of the recurrent laryngeal nerve: experience with an intralaryngeal surface electrode

Horn

Rötzscher

1999

Langenbeck's Archives of Surgery

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By means of an electrode, the nerve was stimulated by a pulsed contact current. The resulting muscle potential was detected using an electrode placed in the larynx. We applied this technique during the time period between 1 January 1997 and 31 December 1998. In 96 cases of primary thyroid resection, the recurrent nerve was identified 167 times. The patients were operated on for nodular thyroid (n=85), Grave's disease (n=9) and malignant papillary goiter (n=2). Retrospectively, the rate of intraoperative nerve injury, equivalent to the rate of postoperative transient and permanent nerve palsy, was 1.04% in the 96 patients and 0.60% with respect to the 167 nerves at risk. The rate of failure of the method was 7.29%.

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Der intraoperative Schnellschnitt in der Strumachirurgie

Cited by 4 publications

References 5 publications

Differentiated operative therapy of thyroid autonomy (Plummer's disease)

Differentiated operative therapy of thyroid autonomy (Plummer's disease)

Intraoperatives neurophysiologisches Monitoring (IONM) des Nervus recurrens und Mikrodissektion - Operationstechnische Verfahren zur Risikominderung von Recurrensparesen -

Intraoperative electromyogram monitoring of the recurrent laryngeal nerve: experience with an intralaryngeal surface electrode

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