Organ Sparing Surgery
From a practical perspective, incomplete laboratory parameters, no thyroid scintigram, and the decision against fine-needle aspiration biopsy are the hindrances to defining the indication for thyroid nodule surgery. Data from the statutory health insurers confirm this individual clinical experience (1). At this point in time, patients are more prepared to interpret surgery to the wrong side of the thyroid as alleged surgical malpractice (2) than surgery to both thyroid lobes during the same procedure. In this setting, expert witnesses and judges will condemn doctors who operated organ sparingly and thereby unintentionally caused the need for a second operation. The fear of cancer determines the decision about total thyroid resection—in the reported case of surgery to the wrong side of the thyroid as well as in a multitude of operations for benign nodular goiter.
The consequences will have to be:
- Individually tailored information about the risks and benefits of surgery for thyroid nodules
- Facilitating the observation of nodules in specialized institutions
- Preparation of performance data held by the Associations of Statutory Health Insurance Physicians, in order to provide quality enhancing advice to physicians.
The following objectives should be aimed for:
- To conduct a complete set of preoperative examinations
- To reduce the number of operations for nodular goiter
- To increase the proportion of Dunhill procedures
- Watchful monitoring of the frequency of thyroid malignancies.
Dr. med. Martin P. Wedig
|1.||Wienold R, Scholz M, Adler JB: Versorgung bei Schilddrüsenknoten: Eine retrospektive Analyse von Krankenkassendaten, Dtsch Arztebl Int 2013; 110: 827–34 VOLLTEXT|
|2.||Wüller M, Bauer R: Eingriffsverwechselung: die falsche Seite operiert. Westfälisches Ärzteblatt 2014; 55–6.|
|3.||Rayes N, Seehofer D, Neuhaus P: The surgical treatment of bilateral benign nodular goiter—balancing invasiveness with complications. Dtsch Arztebl Int 2014; 111: 171–8. VOLLTEXT|