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Das beinhaltet ein befundad\u00e4quates Resektionsausma\u00df und eine m\u00f6glichst niedrige Komplikationsrate. Der Chirurg sollte fr\u00fchzeitig in die Operationsindikation eingebunden sein und auch selbst die Diagnostik, speziell den Schilddr\u00fcsen- und Halslymphknotenultraschall, sowie die Interpretation der Schnittbild- und nuklearmedizinischen Verfahren beherrschen. Im Besonderen sollte er \u00fcber zeitgem\u00e4\u00dfe Radikalit\u00e4tsprinzipien in der Chirurgie Bescheid wissen.<\/jats:p><jats:p>Bei der <jats:bold>gutartigen Struma<\/jats:bold> ist eine individualisierte Operationsstrategie anzuwenden: Solit\u00e4rknoten k\u00f6nnen auch einer gewebeschonenden Knotenresektion unterzogen werden. Bei multinodul\u00e4rer Knotenstruma ist nicht zwingend eine totale Thyreoidektomie notwendig, die Vermeidung eines permanenten Hypoparathyreoidismus hat Priorit\u00e4t. Bei Rezidivstrumen ist oft die einseitige Operation des dominanten Befundes zu bevorzugen. Auch besteht zunehmend der Trend, die Indikation zur Entfernung der Schilddr\u00fcsenlappen seitengetrennt zu stellen. Die Basedow Struma erfordert eine Thyreoidektomie. Auch die hypertrophe Thyreoiditis Hashimoto kann eine Operationsindikation darstellen.<\/jats:p><jats:p>Die Radikalit\u00e4tsprinzipien bei <jats:bold>maligner Struma<\/jats:bold> haben sich ebenfalls deutlich gewandelt als auch die strenge Indikation zur Radiojodtherapie. Das gilt speziell f\u00fcr papill\u00e4re Mikrokarzinome und minimal invasive follikul\u00e4re Tumortypen. Selbst bei medull\u00e4ren Schilddr\u00fcsenkarzinom stehen die Radikalit\u00e4tsprinzipien im Hinblick auf synchrone oder metachrone laterale Halsdissektion in Diskussion.<\/jats:p><jats:p>Der <jats:bold>Hypoparathyreoidismus<\/jats:bold> stellt derzeit das Hauptproblem in der radikalen Schilddr\u00fcsenchirurgie dar. <jats:bold>Recurrensparese<\/jats:bold> und <jats:bold>Nachblutung<\/jats:bold> sind durch die subtile Operationstechnik selten geworden. Spezielle extrazervikale Operationszug\u00e4nge sind nach wie vor in der Erprobungsphase und unter strengen Studienbestimmungen nur Zentren vorbehalten. Die Radiofrequenzablation stellt f\u00fcr gewisse L\u00e4sionen wie Zysten und autonome Adenome bei chirurgischer Kontraindikation ein alternatives Ablationsverfahren dar.<\/jats:p>","DOI":"10.1007\/s10354-020-00750-5","type":"journal-article","created":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T12:03:18Z","timestamp":1587988998000},"page":"379-391","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Moderne Schilddr\u00fcsenchirurgie \u2013 das endokrin-chirurgische Verst\u00e4ndnis des Operateurs und seine Verantwortung f\u00fcr Resektionsausma\u00df und Komplikationsrate","Modern thyroid surgery \u2013 the surgeon\u2019s endocrine-surgical understanding and his responsibility for the extent of surgery and complication rate"],"prefix":"10.1007","volume":"170","author":[{"given":"Michael","family":"Hermann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth","family":"Gschwandtner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max","family":"Schneider","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Handgriff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rupert","family":"Prommegger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,4,27]]},"reference":[{"issue":"5","key":"750_CR1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1007\/s00423-011-0774-y","volume":"396","author":"TJ Musholt","year":"2011","unstructured":"Musholt\u00a0TJ, Clerici\u00a0T, Dralle\u00a0H, Frilling\u00a0A, Goretzki\u00a0PE, Hermann\u00a0MM, et\u00a0al. German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg. 2011;396(5):639\u201349.","journal-title":"Langenbecks Arch Surg"},{"issue":"1","key":"750_CR2","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s10353-013-0247-3","volume":"46","author":"C Bures","year":"2014","unstructured":"Bures\u00a0C, Klatte\u00a0T, Friedrich\u00a0G, Kober\u00a0F, Hermann\u00a0M. Guidelines for complications after thyroid surgery: pitfalls in diagnosis and advices for continuous quality improvement. 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