Background and Aims: There are only few data on the influence of cinacalcet on the outcome of parathyroidectomy in patients with renal hyperparathyroidism. Indication and timing of surgery have changed since its introduction, especially with regard to kidney transplantation. Therefore, we retrospectively analyzed patients undergoing parathyroidectomy for renal hyperparathyroidism in our institution. Material and methods: Between 2008 and 2015, 196 consecutive operations in 191 patients were analyzed. About 80 operations (41%) were performed in patients receiving cinacalcet compared with 116 operations (59%) in patients without cinacalcet. Clinical data, preoperative medication, pre- and postoperative laboratory values, type and details of surgery including complications, as well as cardiovascular complications and kidney transplantation with graft function were recorded. Results: Demographical data were similar in patients with or without cinacalcet treatment. A total of 54% of patients received a kidney graft before or after parathyroidectomy. Pre- and postoperative parathormone levels were similar in both groups (preoperatively 755 vs 742 ng/L, postoperatively 50 vs 46 ng/L, p > 0.10), whereas patients with cinacalcet showed significantly lower calcium levels preoperatively (2.28 vs 2.41 mmol/L, p = 0.0002). There was no difference in recurrence or persistence of hyperparathyroidism, duration of surgery, hospital stay, or complication rate. Creatinine levels in patients with tertiary hyperparathyroidism were similar after 1-year follow-up. Conclusion: Cinacalcet did not influence outcome of patients with parathyroidectomy for renal hyperparathyroidism and can be safely offered to patients not responding to medical treatment.

Minimal-invasive Schilddrüsen- und Nebenschilddrüsenresektionen bei gutartigen und bösartigen Tumoren werden selten durchgeführt. In jüngster Zeit wurden vielversprechende neue endoskopische transorale Ansätze am vorderen Hals mit guten Ergebnissen und geringen Komplikationsraten beschrieben. Diese Studie beschreibt die erste klinische Serie in Deutschland mit der transoralen endoskopischen Thyreoidektomie („transoral endoscopic thyroidectomy – vestibular approach“, TOETVA) und zeigt technische Probleme und Lösungen auf.

Promising new endoscopic transoral approaches to the anterior neck (TOETVA) have been described with good results and few complications, and the first access is key. A new device is proposed to allow the safe entrance of trocars in the subplatysmal space.

Super-Superobese patients (BMI higher then 60 kg/m2) are of difficult primary bariatric management. Issues regarding exposure and technical difficult anastomosis led to the choice of a 2-stage procedure, usually a sleeve gastrectomy as the first step. In the majority of cases, patients have an unsatisfactory EWL (excess weight loss) after 2 years and high rates still remain in obesity class III.

Wundinfektionen nach Schilddrüsenoperationen sind überwiegend oberflächlich und gut zu therapieren. Eine Streptokokkenmediastinitis nach Thyreoidektomie stellt eine sehr seltene, jedoch lebensbedrohliche Komplikation dar.

Surgical site infections after thyroid surgery are mostly superficial and can be well treated. Streptococcal mediastinitis in contrast is a rare but life-threatening complication.A 57-year-old female patient experienced septic fever, increase of inflammation parameters and erythema 2 days after thyroid surgery for Graves' disease. This process was triggered by a three-compartment infection by group A Streptococcus (GAS) with involvement of the mediastinum. Therapy over 6 weeks including seven wound revisions with the patient under general anesthesia, pathogen-adapted antibiotic treatment and cervical negative pressure treatment managed to control the infection. A total of 21 cases have been published on this phenomenon, 11 of which had a fatal outcome.High fever and surgical site erythema in the early postoperative period after thyroid surgery can be signs of a GAS infection, which might lead to necrotizing, descending, life-threatening mediastinitis. Early diagnosis with support of computed tomography (CT) scans, immediate therapy including wound opening, lavage, intravenous antibiotic treatment with penicillin and clindamycin are vital. If treatment resistance occurs, cervical negative pressure treatment should be considered.

There are four major complications after thyroidectomy, including palsy of the recurrent laryngeal nerve (RLN), hypoparathyroidism, postoperative bleeding, and surgical site infection (SSI). Another clinical problem is the injury and palsy of the external branch of the superior laryngeal nerve (EBSLN). We present a 1-year analysis of our prospective data on complications and outline our guidelines for follow-up and management, including quality assessment.

BACKGROUND:A small subset of patients may develop late-onset palsy of the recurrent laryngeal nerve (RLN) after thyroid surgery. However, no conclusive data have been published regarding the incidence of, and possible risk factors for, this complication.METHODS:Preoperative, intraoperative and postoperative data from consecutive patients who underwent thyroid surgery at a single centre between 1999 and 2012 were analysed. Late-onset palsy of the RLN was defined as deterioration of RLN function after normal vocal cord function as investigated by routine preoperative and postoperative laryngoscopy.RESULTS:The cohort included 16 692 patients with 28 757 nerves at risk. Early postoperative palsy of the RLN was diagnosed in 1183 nerves at risk (4·1 per cent), whereas late-onset RLN palsy was found in 41 (0·1 per cent). Late-onset palsy of the RLN was diagnosed after a median interval of 2·5 (range 0·5-12) weeks and nerve function recovered completely in 28 patients after a median interval of 3 months. This recovery rate was significantly lower than that for early-onset RLN palsy: 1068 (90·3 per cent) of 1183 nerves (P < 0·001). No particular risk factor for late-onset RLN palsy was identified.CONCLUSION:Late-onset palsy of the RLN was diagnosed in a small subset of patients after thyroid surgery, and recovery of nerve function occurred less frequently than in patients with early-onset RLN palsy.

In reoperation for hemorrhage after thyroid surgery, the source of bleeding is frequently undetectable.