[Educational Video: Hemithyreoidectomy with Neuromonitoring of the Recurrent Laryngeal Nerve].

Abstract:

INTRODUCTION:The mean prevalence of thyroid nodules in adults is about 20% and increases with age. Most of the thyroid nodules are benign, and are rarely malignant. However, malignancy can often only be conclusively determined after resection. Therefore, it is essential that the surgical technique should be free of complications. Despite all published minimally invasive techniques, the open procedure via a Kocher incision is still standard and commonly used in a teaching setting. This standardised technique is presented step-by-step in the video. INDICATION:Sonographic and MIBI-scintigraphic possibly malignant solitary node in the right thyroid lobe. PROCEDURE:Hemithyreoidectomy with neuromonitoring of recurrent laryngeal nerve. CONCLUSION:Hemithyroidectomy is an adequate primary therapy for a solitary possibly malignant thyroid nodule. Intraoperative neuromonitoring to identify and protect the recurrent laryngeal nerve, visualisation and protection of the parathyroid glands without compromising blood circulation and careful hemostasis are the main pillars of low risk surgery of the thyroid. EINLEITUNG:Die Prävalenz von Schilddrüsenknoten im Erwachsenenalter liegt durchschnittlich bei etwa 20% und nimmt mit zunehmendem Alter zu. Bei einem Großteil der Schilddrüsenknoten handelt es sich um benigne Veränderungen, nur selten liegen maligne Befunde vor. Allerdings kann die endgültige Dignität nicht selten erst nach erfolgter Resektion bestimmt werden. Wichtig ist daher eine komplikationsarme Operationstechnik. Standard der Resektion und Weiterbildungseingriff ist bei allen publizierten minimalinvasiven Techniken die offene Operation über einen Kocher-Kragenschnitt. Diese Technik soll in diesem Lehrvideo Schritt für Schritt dargestellt werden. INDIKATION:Sonografisch und MIBI-szintigrafisch malignitätsverdächtiger solitärer Knoten im rechten Schilddrüsenlappen. PROZEDUR:Hemithyreoidektomie rechts mit Neuromonitoring des N. laryngeus recurrens. SCHLUSSFOLGERUNG:Bei solitärem malignitätsverdächtigen Schilddrüsenknoten stellt die Hemithyreoidektomie die adäquate primäre Therapie dar. Die Verwendung eines intraoperativen Neuromonitorings zur sicheren Identifikation und Schonung des N. laryngeus recurrens, die Darstellung und Schonung der Nebenschilddrüsen ohne Kompromittierung der Durchblutung sowie eine sorgfältige Blutstillung stellen die wichtigsten Pfeiler einer risikoarmen Operation an der Schilddrüse dar.

journal_name

Zentralbl Chir

authors

Brunner M,Bleichroth H,Linke K,Krautz C,Weber GF,Grützmann R,Kersting S

doi

10.1055/a-1024-4662

subject

Has Abstract

pub_date

2019-12-01 00:00:00

pages

525-529

issue

6

eissn

0044-409X

issn

1438-9592

journal_volume

144

pub_type

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