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Introduction: Quality assurance of the thyroid surgery has been an important part of the work of the endocrine surgeon. For most analyses, data from register files or studies have been used. Administrative data taken from routine data are increasingly used in quality assurance for evaluation. The aim of the study is to determine the reliability of routine data to analyse the treatment outcome and complications of thyroid surgery., Patients and Methods: In a cross-sectional study, we compared records of 121 patients with thyroid surgery for one year with the data of quality assurance of clinical routine. We determined sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of complications., Results: Screening of administrative data identified 40 specific complications; 84 by patient records. Sensitivities for the detection of complications using administrative data ranged from 31.3 to 60.0%. Specificities ranged from 97.0 to 100%; PPV were 0.77 - 1.0 and NPV were 0.56 - 1.0., Conclusion: Quality assurance of clinical routine data of the thyroid surgery shows deficiencies in sensitivity accompanied by high specificity. It is necessary to increase the validity of administrative routine data to carry out a reliable clinic quality analysis or to prepare volume-outcome relationships in clinical health service research. The parameter of hypocalcaemia shows the most limitations due to quality assurance of clinical routine data., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Two decades ago, single-incision surgery was established as a new concept in minimally invasive surgery. Single incision cholecystectomy is the most frequently performed procedure in clinical routine. Most of the results have been based on randomised trials. Large prospective multicentre observational datasets from clinical routine do not exist. This analysis of clinical health service research is based on the SILAP study (single-incision multiport/single port laparoscopic abdominal surgery study)., Patients and Methods: The data of the register were collected in 47 hospitals in the period of 2012 to 2014. Overall morbidity and mortality were the primary outcome. Multiple linear and logistic regression analyses were performed. Statistical significance was set at p < 0.05., Results: Data from 975 patients in clinical routine with single incision cholecystectomy were collected. Intraoperative complications were recorded in 3.2% of cases. Bile duct injuries were registered in 0.1% of cases. Postoperative complications were detected in 3.7% of cases. The mortality rate was 0.2%.The median operating time dropped from 60.0 to 51.5 min (p < 0.001) during the study. The use of an extra trocar was necessary in 10.3% of cases. Conversion to open surgery was performed in 0.7% of cases. Body mass index (p = 0.024), male gender (p = 0.012) and operating time (p < 0.001) had a significant effect on intraoperative complications in multivariate analysis. Classification of ASA III (p = 0.001) and modification or conversion of single incision technique (p = 0.001) were significantly associated with postoperative complications., Conclusion: The register analysis of the prospective multicentre data shows that single incision cholecystectomy is feasible in clinical routine even outside the selective criteria of randomised studies. The only limitation is a BMI > 30 kg/m 2 which has a significant influence on the intraoperative rate of complications in mild adverse events., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Approximately 90,000 thyroid operations are performed in Germany each year. Minimally invasive video-assisted thyroidectomy (MIVAT) accounts for 5 - 10% of these operations. There are few data that compare long-term cosmetic results after MIVAT to those after conventional surgery. Current systematic reviews show no advantage for MIVAT. The goal of this study was to analyse the long-term postoperative results in both procedures and the evaluation of relevant factors., Patients and Methods: The analysis of the long-term results is based on follow-up examinations using a validated method for scar appraisal (POSAS). Cohort analysis was performed on MIVAT operations in our hospital between 2004 and 2011 and conventional thyroid operations in 2011., Results: Follow-up examination data were analysed from 117 patients from the MIVAT group and 102 patients from the conventional group. The follow-up examination was performed with a mean of 23.1 vs. 23.6 months postoperatively (MIVAT vs. conventional). The Friedman Test showed that scar pigmentation (mean rank 4.79) and scar surface structure (mean rank 3.62) were the deciding factors influencing the long-term cosmetic results., Conclusion: Both MIVAT and conventional surgery gave very good long-term cosmetic results. From the patient's perspective, there is no significant advantage with conventional surgery. The evaluation of the long-term results largely depends on factors such as scar pigmentation and surface structure that can only be influenced to a limited extent by the surgical procedure., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: With about 135,000 operations every year appendectomy is one of the most frequent surgical operations in Germany. Acute appendicitis has shown changes in diagnosis and therapy with time. The status of the laparoscopic appendectomy has had to be redefined recently. The aim of this study was to make an analysis of the current surgical therapy for appendicitis and the individual procedures., Patients and Methods: Three prospective multi-centre quality assurance studies (1988 / 89, 1996 / 97; 2008 / 09) of the "An-Institut" acquired 17,732 treatments from all supply levels of Germany., Results: The average age of patients increased within of the three studies from 25.7 to 34.6 years. Within the studies in 1996 / 97 and in 2008 / 09 the share of laparoscopic appendectomy advanced from 33.1 to 85.8 percent. In the study from 2008 / 09 the laparoscopic appendectomy showed a significant advantage over the conventional technique in terms of wound-healing disturbances (p < 0.001) and a clinical duration of stay (p < 0.001). At no stage of the appendix inflammation did the laparoscopic appendectomy lead to a significant increase of intraabdominal abscesses. Compared with the conventional technique the operating time was shorter (46.6 min vs. 53.5 min). Currently the use of a stapler is the mostly frequently applied method of appendiceal stump closure (83.6 percent)., Conclusion: The laparoscopic appendectomy is the most common method of current operative therapy. In comparison to former publications, there is no proof of any disadvantages of laparoscopic appendectomy., (© Georg Thieme Verlag KG Stuttgart · New York.)

Colon carcinomas are the most common malignant tumours in the Western world. Important findings about the overall quality of medical care have been reported in multi-centre observational studies. A quality enhancement of therapeutic care can be achieved by an additional increase in diagnostic and therapeutic measures in the interdisciplinary setting. The development of colon cancer centres improves the chance to objectively observe the results of medical care induced by the development of an interdisciplinary and cross-sectoral unit that includes a comprehensive medical care for patients. The implementation of the current medical findings based on evidence in clinical routine, the inspection of the usage of guidelines by external specialists as part of an audit and the continuous correction of analysed deficits in the course of treatment guarantee a continuous improvement of service., (Georg Thieme Verlag KG Stuttgart · New York.)

Appendicitis is the most common cause of an -acute abdomen. Around 135 000 patients undergo appendectomy in Germany every year. Acute -appendicitis shows changes in epidemiology, -diagnosis and therapy. Epidemiological data indicate a continuing decrease in the incidence of acute non-perforated appendicitis. The incidence of perforated appendicitis has remained constant despite laparoscopy and imaging diagnostics. The status of sonography and CT scanning is increasing in the diagnosis of appendicitis. But there are differences between the sensitivity and specifity of study results and the clinical routine. The in-crease of imaging diagnostics does not correlate with a decrease in the incidence of perforated -appendicitis. Laparoscopic appendectomy has -developed as a dominant method for operative therapy. There is no proof of a higher rate of postoperative intraabdominal abscesses any more. The use of a stapler is mostly required for appendical stump closure., (© Georg Thieme Verlag Stuttgart ˙ New York.)

We report on further developments of the rectusbanding variation II method which is used for the repair of large incisional hernias in 70 patients. Using this method the musculus rectus abdominis is not entirely looped. Instead, the polypropylene bands, which have been placed in sublay position, are penetrating the lateral rim through incisions and are fastened there. Important to note that the polypropylene bands are not used to ligate the abdominal wall. The bands must be placed loosely. This allowed us to reduce the applied material by almost 50 per cent. Although a high number (n = 70) of large incisional hernias (about 150 cm (2), variation I n = 16/20,3%, variation II n = 29/41,4%) were operated upon with this method (rectusbanding variation II) previous excellent results could be further improved (wound infectionrate 2,8%, recurrence rate after 18 months 0%, patients had no complaints and their mobility was excellent). Only the seroma formation rate was slightly increased due to the large size of the hernias. These excellent results are mainly based on the absolutely reliable fixing of the polypropylene bands and the complete mesh coverage by soft tissue. This method can be easily learned by any surgeon and is a true alternative to all conventional methods which have been published so far. In particular laparoscopic methods for incisional hernia repair can be replaced by this technique.

We report on 431 operations in conventional visceral surgery with the general use of the ultracision technique for preparation (thyroid resections n = 356, colonic resections n = 28, local excisions of the gastric wall n = 3, gastrectomy n = 14, anterior resections of the rectum n = 19, abdominoperineal resection of the rectum [Miles' operation] n = 11). Ligatures were only used for truncal blood vessel ligation. A thorough study of the technical possibilities is a prerequisite for the use of the ultracision technique. The general use of the ultracision technique leads to a revolutionary change of the surgical technique and saves a considerable amount of suture material. In combination with the use of bipolar electrocoagulation the ultracision technique makes the operation fast and leads to a major reduction of bleeding. The biggest disadvantage of the ultracision technique in comparison to the conventional surgical technique is the high cost of the device at present. Despite of savings of suture material, swabs and blood transfusions, the costs for the ultracision scissors are still higher due to its single use.

From 1/1995 to 8/1997 857 appendectomies were observed in a prospective study. From then on in our clinic has done more laparoscopic then conventional operations, and has developed in the years before a permanent laparoscopic team. For all operations resterilized MIC-instruments are used. Preparation is done with bipolaric instruments and scissor, the appendix stump is supplied a with Röder-sling. The expensive Endo-GIA was used only 3x, if the coecumpole was also inflamed. Because of the fantastic intraabdominal view additional findings quickly be recognized through the laparoscopic method. It was then possible, to plan the therapeutic management exactly. Also variations of the appendix-position are seen clearly and can be operated on without other incisions. There is no significant difference in time between the two methods as we have seen here in practice (35.3 minutes for the conventional and 43.8 for the laparoscopic operation)--they will assimilate, when the surgeon is routine. Fat and muscular patients profit definitely. The problems of wound infection have been rarely observed by the laparoscopic operation. The rate of intraabdominal abscesses was 1.9% and therefore higher as by the conventional method (0.2%). This could be reduced during the period of the study, because we now often lavage and drain. We think that there are no surgical opponent indication to the laparoscopic appendectomy. The reliable conventional technique has to be an obligate technique also in future.