Rekurrens- und Nebenschilddrüsenpräparation in der Schilddrüsenchirurgie

Abstract

Subtotal thyroid resection in the case of benign goiter carries a high risk of recurrence. The relatively high rate of postoperative cancer findings also leads frequently to secondary completion thyroidectomy. Internationally therefore the paradigm has shifted from subtotal resection to extended or total thyroidectomy, which shifts the risk to the vocal cords and parathyroids, where as a rule complications are much worse than those to the thyroid. The main surgical goal therefore is avoiding as far as possible recurrent laryngeal nerve palsy and disturbances to parathyroid function following extended resection. With adequate training and technical intraoperative aids for preserving anatomy and function of the vocal cords (neuromonitoring) and parathyroids (parathyroid hormone monitoring) the risk of complications after extended resection is not significantly higher than after classic subtotal resection without identification of the nerve and parathyroids.

State of the art: surgery for endemic goiter—a plea for individualizing the extent of resection instead of heading for routine total thyroidectomy

“…Despite the introduction of magnifying glasses and intraoperative nerve monitoring [14,16], surgical experience still remains more important for minimizing surgical risk than these new technologies [11,12]. It may be important to note that RLN palsy is often followed by dysphagia in addition to dysphonia and that postoperative hypoparathyroidism cannot always be treated well with calcium and vitamin D supplements [2].…”

“…From the very beginning, surgery for endemic goiter [15,19,27,29,35] has been winding its way between the need to remove all diseased thyroid tissue as a potential source of recurrence, often implying total thyroidectomy, and the greater morbidity associated with the procedure [4,5,10,11,14,20,25,34,37,48,50]. Endemic multinodular goiter, representing the final stage of iodine deficiency [30], involves the thyroid gland as a whole.…”

Intraoperatives Neuromonitoring bei Schilddrüsenoperationen

“…Nach jahrzehnte langen Debatten über das Für und Wi der der Nervendarstellung hat sich heu te die Überzeugung durchgesetzt, dass bei Schilddrüsenresektionen in Nervennähe, d. h. insbesondere bei der totalen Lap penresektion, die visuelle Nervendarstel lung die bestmögliche Voraussetzung, den "Goldstandard", zur Schonung des N. re currens darstellt [3,4,8] …”

Das Bild der Grenzlamelle in der Schilddrüsenchirurgie

“…Dralle hat in überragender Weise ausführ-lich über Entwicklung und Fortschritte der Operationstechnik in der Schilddrü-sen (SD)-Chirurgie berichtet [2].…”