Thyroid surgery is associated with three significant complications: vocal cord palsy due to an injury to the recurrent laryngeal nerve, postoperative bleeding, and hypoparathyroidism resulting in clinically relevant and symptomatic hypocalcaemia. Quality control and continuous quality improvement have become important aspects of modern medicine within the last decades. Accordingly, my major scientific research areas in the field of thyroid surgery include the refinement of surgical techniques in order to decrease complication rates, risk factor analyses for specific complications, strategies for an optimizing of the management of (post-) operative complications as well as studies on quality control and management. Moreover, the scientific team also works interdisciplinarily with departments of pathology/histology, nuclear medicine and gynecologic endocrinology.
Notably, studies on thyroid surgery demonstrated significant differences in complication rates. Thus, continuous quality improvement in global outcome may be achieved by monitoring and retraining of surgeons. From my experience, surgeons do not only differ in terms of their individual complication rates but also concerning their self-assessment. Hence, it is of a high interest to evaluate the individual surgeons’ quality of risk assessment and to compare these with the actual results. These issues are current research-aspects and are evaluated out in the course of an actual post-doc study.
All in all, the scientific focus is on (i) analyses of the uninterrrupted quality system record of thyroid patients, who were operated in our department (former Kaiserin Elisabeth Spital, now the Second Department of Surgery “Kaiserin Elisabeth”, Krankenanstalt Rudolfstiftung) since the late 1970s, which allows to analyze different thyroid issues in over 30.000 patients; and on (ii) prospective studies including studies on neuromonitoring or quality control in thyroid surgery.
Methods & Techniques
Schneider R, Bures C, Lorenz K, Dralle H, Freissmuth M, Hermann M. Evolution of nerve injury with unexpected EMG signal recovery in thyroid surgery using continuous intraoperative neuromonitoring. World J Surg 37: 364-368, 2013
Promberger R, Hermann M, Pallikunnel SJ, Seemann R, Meusel M, Ott J. Quality of life after thyroid surgery in women with benign euthyroid goiter: influencing factors including Hashimoto's thyroiditis. Am J Surg [Epub ahead of print], 2013 Sep 23
Dionigi G, Kraimps JL, Schmid KW, Hermann M, Sheu-Grabellus SY, De Wailly P, Beaulieu A, Tanda ML, Sessa F. Minimally invasive follicular thyroid cancer (MIFTC)-a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg. [Epub ahead of print], 2013 Nov 14
Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A; German Societies of General and Visceral Surgery; Endocrinology; Nuclear Medicine; Pathology; Radiooncology; Oncological Hematology; and the German Thyroid Cancer Patient Support Organization Ohne Schilddrüse leben e.V. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 398: 347-375, 2013
Promberger R, Ott J, Kober F, Koppitsch C, Seemann R, Freissmuth M, Hermann M. Risk factors for postoperative bleeding after thyroid surgery. Br J Surg 99: 373-379, 2012
Schneider R, Lamade W, Hermann M, Goretzki P, Timmermann W, Hauss J, Leinung S. [Continuous intraoperative neuromonitoring of the recurrent laryngeal nerve in thyroid surgery (CIONM) - Where are we now? An update to the European Symposium of Continuous Neuromonitoring in Thyroid Surgery]. Zentralbl Chir 137: 88-90, 2012
Musholt TJ, Clerici T, Dralle H, Frilling A, Goretzki PE, Hermann MM, Kussmann J, Lorenz K, Nies C, Schabram J, Schabram P, Scheuba C, Simon D, Steinmüller T, Trupka AW, Wahl RA, Zielke A, Bockisch A, Karges W, Luster M, Schmid KW; Interdisciplinary Task Force Guidelines of the German Association of Endocrine Surgeons. German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 396: 639-649, 2011
Ott J, Meusel M, Schultheis A, Promberger R, Pallikunnel SJ, Neuhold N, Hermann M.The incidence of lymphocytic thyroid infiltration and Hashimoto's thyroiditis increased in patients operated for benign goiter over a 31-year period. Virchows Arch 459: 277-281, 2011
Ott J, Promberger R, Kober F, Neuhold N, Tea M, Huber JC, Hermann M. Hashimoto's thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter. Thyroid 21: 161-167, 2011
Promberger R, Ott J, Kober F, Karik M, Freissmuth M, Hermann M. Normal parathyroid hormone levels do not exclude permanent hypoparathyroidism after thyroidectomy. Thyroid 21: 145-150, 2011