German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease

Musholt, Thomas J.; Clerici, Thomas; Dralle, Henning; Frilling, A.; Goretzki, P. E.; Hermann, Michael; Kußmann, J; Lorenz, Kerstin; Nies, C.; Schabram, J.; Schabram, P; Scheuba, Christian; Simon, Dietmar; Steinmüller, Thomas; Trupka, A.; Wahl, R. A.; Zielke, A.; Bockisch, Andreas; Karges, Wölfram; Luster, Markus; Schmid, Kurt Werner

doi:10.1007/s00423-011-0774-y

Cited by 158 publications

(115 citation statements)

References 50 publications

(63 reference statements)

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“…In all studies, there was no deliberate attempt to identify the parathyroid glands. The visual identification of parathyroids by targeted dissection is of decisive importance in minimizing the risk of parathyroid dysfunction [27,31]. …”

Section: Discussionmentioning

confidence: 99%

Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease in Parathormone without Clinically Manifest Hypoparathyroidism: A Randomized Clinical Trial

2015

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Background: Bilateral truncal ligation (BTL) of the inferior thyroid artery (ITA) is frequently used during subtotal thyroidectomy to reduce the risk of post-operative bleeding as well as to reduce the blood loss intra-operatively. However, its effect on parathyroid function has not been evaluated in relation to age, residual and resected thyroid volume. Methods: A total of 83 patients were randomized to receive non-BTL or BTL. After bilateral resection, the residual thyroid tissue on each side was measured by intra-operative ultrasonography. Laboratory and clinical examinations were performed the day before operation, intra-operatively and on post-operative days 2 and 5. The primary outcome measure was the difference in intact parathormone (PTHi) on post-operative day 5. Secondary outcomes were laboratory-diagnosed hypocalcaemia or hypoparathyroidism and clinically manifest hypoparathyroidism, respectively. Results: PTHi on post-operative day 5 was significantly lower in the BTL group (29.4 vs. 34.7 ng/l in the non-BTL group, p = 0.033), especially in 61- to 80-year-old patients (0 vs. -7.91 ng/l, p = 0.029). The biggest decline in PTHi was found in the BTL group (-14.067 ng/l PTH, p = 0.018) with a residual thyroid volume of 0.5-1.9 ml. There were two cases of asymptomatic hypoparathyroidism in each group (5.1 vs. 4.8%, respectively, p = 1.000). The only case of clinically manifest hypoparathyroidism was in a BTL group patient aged 64 years (2.4%, p = 1.000). Conclusion: BTL of the ITA during subtotal thyroidectomy causes a larger decrease in PTH but does not lead to a significantly higher rate of clinically manifest hypoparathyroidism. BTL of the ITA, age >61 years, and a very small thyroid remnant (<2 ml) may be risk factors for post-operative hypoparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease in Parathormone without Clinically Manifest Hypoparathyroidism: A Randomized Clinical Trial

2015

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“…Die Identifikation des N. laryngeus recurrens (NLR) in der Schilddrüsenchirurgie ist etabliert und in den aktuellen Leitlinien verankert [20]. Das Aufsuchen und die sichere visuelle Identifikation des NLR setzen die Kenntnis des anatomischen Verlaufes und mögliche Lagevarianten voraus (.…”

Section: Nervenläsionenunclassified

Intraoperative Komplikationen bei Operationen im Halsbereich

Simon

Lassau

Schmidt-Wilcke

et al. 2012

Chirurg

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Intraoperative complications of neck surgery are uncommon and rarely life-threatening and exact anatomical knowledge and precise dissection are most important for prevention. Anatomical variants (e.g. non-recurrent nerve, extralaryngeal branching) predispose to damage of the recurrent laryngeal nerve. The use of intraoperative neuromonitoring (IONM) can prevent bilateral nerve damage but in cases of accidental nerve damage primary reconstruction can improve vocal cord function. Autotransplantation of parathyroid tissue can reduce the rate of hypoparathyroidism but cannot be postulated as a routine measure. Intraoperative bleeding can usually be well controlled and greater danger for the patient emanates from early postoperative bleeding for which many techniques (clip, ligature, vessel sealing) can be employed for prevention. Lesions of the thoracic duct can be controlled by clip, ligation or stitch. Smaller lesions of the trachea and esophagus can be secured with direct suture or muscle flap plasty. In cases of larger lesions plastic reconstruction or organ replacement can be necessary.

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“…Thyroidectomy was a common procedure with more than 100,000 operations performed in Germany [1]. Con-ventional thyroid surgery routinely produces successful outcomes and is known to have a high safety profile [2] [3].…”

Section: Introductionmentioning

confidence: 99%

Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot<sup>&reg</sup>) with Conventional Haemostatic Procedure after Thyroid Resection

Ahnen¹,

Ahnen²,

Wirth³

et al. 2015

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Background: Postoperative hemorrhage remains an uncommon but potentially life-threatening complication of thyroid surgery. The aim of this case-controlled study was to compare the effectiveness of PerClot ® hemostatic agent with hemostasis by conventional technique (HCT) in thyroid surgery. Methods: The thyroid resection was performed from November 2009 to February 2010. Exclusion criteria were applied. There were 30 patients in the HCT group and 30 patients in the PerClot ® group. The outcome parameters were postoperative bleeding, the drainage volume 24 hours postoperatively and adverse events according to PerClot ® . Results: There was no postoperative hemorrhage in both groups. We found no significant difference between the control and PerClot ® group with regard to total drainage volume after 24 h (51 ml ± 36.9 control group/53 ml ± 39.5 PerClot ® group (p = 0.79)). There were no adverse events in the PerClot ® group. Conclusions: Routine use of PerClot ® hemostatic agent has no advantage over conventional hemostasis technique (HCT) in thyroid surgery. In addition, PerClot ® is safe and well tolerated.

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German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease

Cited by 158 publications

References 50 publications

Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease in Parathormone without Clinically Manifest Hypoparathyroidism: A Randomized Clinical Trial

Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease in Parathormone without Clinically Manifest Hypoparathyroidism: A Randomized Clinical Trial

Intraoperative Komplikationen bei Operationen im Halsbereich

Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot<sup>&reg</sup>) with Conventional Haemostatic Procedure after Thyroid Resection

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German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease

Cited by 158 publications

References 50 publications

Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease in Parathormone without Clinically Manifest Hypoparathyroidism: A Randomized Clinical Trial

Bilateral Truncal Ligation of the Inferior Thyroid Artery during Bilateral Subtotal Thyroidectomy Causes a Decrease in Parathormone without Clinically Manifest Hypoparathyroidism: A Randomized Clinical Trial

Intraoperative Komplikationen bei Operationen im Halsbereich

Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot&lt;sup&gt;&amp;reg&lt;/sup&gt;) with Conventional Haemostatic Procedure after Thyroid Resection

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Comparison of an Intraoperative Application of a Haemostatic Agent (PerClot<sup>&reg</sup>) with Conventional Haemostatic Procedure after Thyroid Resection