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Background Abdominal cocoon or "encapsulating peritoneal sclerosis" (EPS) is an uncommon and rare cause of intestinal obstruction. Only a few cases have been reported in paediatric patients. Typically, EPS is described as the primary form in young adolescent girls from tropical and subtropical countries because of viral peritonitis due to retrograde menstruation or a history of peritoneal dialysis. Most patients are asymptomatic or present with abdominal pain, which is likely to occur secondary to subacute bowel obstruction. Findings at imaging, such as ultrasound, computed tomography, and magnetic resonance imaging, are often nonspecific. When diagnosed, EPS is characterized by total or partial encasement of the bowel within a thick fibrocollagenous membrane that envelopes the small intestine in the form of a cocoon because of chronic intraabdominal fibroinflammatory processes. The membrane forms a fibrous tissue sheet that covers, fixes, and finely constricts the gut, compromising its motility. Case summary We present a case of EPS in a 12-year-old boy 8 wk after primary surgery for resection of symptomatic jejunal angiodysplasia. There was no history of peritoneal dialysis or drug intake. Conclusion In this report, we sought to highlight the diagnostic, surgical, and histopathological characteristics and review the current literature on EPS in paediatric patients.

Aneurysms of the ulnar artery and its palmar arch are usually rare events, which are mostly related to repetitive trauma of the extremity. This syndrome is also known as hypothenar hammer syndrome, which presents two pathologic entities: the aneurysmal type and the thrombotic type. Whereas surgical treatment is not necessary within the thrombotic type, it is the gold standard to treat aneurysms of the palm with resection of the aneurysm and reconstruction of the vessel with either end-to-end anastomosis, venous or arterial grafts. We report a case of a young male patient with an aneurysm of the right ulnar artery at the wrist with history of repetitive trauma. Reconstruction with a venous forearm graft showed recurrence of the aneurysm after 2 years from surgery. The authors want to elaborate an algorithm for surgical treatment to make the right decision for choice of reconstruction. Level of evidence: Level IV, therapeutic study.

The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.

Allergic reactions occurring after tattooing, especially after the use of red tattoo ink ingredients are relatively rare. We report a painful skin reaction occurring 6 months after the tattoing of the right lower extremity in a 30-year-old female patient. Pathohistological and immunchemical results confirmed a pseudolymphoma. Only the tangential excision of the affected areas led to a sufficient healing process. Split thickness skin grafts were used for defect coverage. 2 years later, the patient was still pain free and the wounds had healed completely without any irritation.

BACKGROUND Due to various options for tissue resection and preoperative markings, many different reports on aesthetics and patient’s satisfaction exist. To assess differences among tissue resections and risk factors, we herein analyzed satisfaction levels of patients that underwent upper blepharoplasty. METHODS A retrospective analysis during the period from January 2006 to June 2013 was conducted by reviewing patient’s electronic medical files. All patients underwent medically indicated upper blepharoplasty at our department. We classified patients relating to resected tissues; hence the categories created were skin, skin/muscle, skin/muscle/fat and skin/fat. Furthermore, an evaluation of risk factors according to the patient’s number of present medical preconditions ranging from 0 (none) to 4 was performed. Data collection was conducted by reviewing patient’s electronic medical files. Moreover, a questionnaire concerning patient’s satisfaction was forwarded. RESULTS No significant differences in patient’s satisfaction and complication rates comparing the different groups of tissue resection were noted. However, we found a significantly higher complication rate at a presence of 2 risk factors. In addition, a significantly worse scar outcome and longer recovery periods in patients with 4 risk factors were observed. CONCLUSION The extent of tissue resection has no statistically quantifiable effect on patient’s satisfaction ratings and complications. For this reason, we believe cautious resection of muscle and fat is only indicated if pathologies are present. Moreover, patients with 2 risk factors or more shall be rigorously evaluated preoperatively to avoid complicating events. An abbreviated form of this manuscript was presented at the conjoint 52nd and 45th annual meeting of the Austrian and German Society of Plastic, Aesthetic and Reconstructive Surgery, September 11th-13th 2014 in Munich, Germany.

Hintergrund: Eine verbreitete Behandlungsalternative bei verschiedensten Gründen für chronische Schmerzzustände des Handgelenkes stellt die 1966 von Wilhelm entwickelte Methode der Denervierung dar. Untersuchungen zu Veränderungen der Eigenschaften des umgebenden Gewebes liegen jedoch[zum vollständigen Text gelangen Sie über die oben angegebene URL], 48. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 55. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie, 22. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC)

Background Vascularized bone grafts of the hand are a promising option for treatment of hand abnormalities. Therefore, the purpose of this study was to analyze the arterial anatomy of the dorsal aspect of the second metacarpal base to further investigate this possible donor site for bone grafts. Methods The authors examined 16 fresh frozen cadaveric hands by using a C-arm cone beam computed tomography scanner and depicted the three-dimensional course of the second dorsal metacarpal artery and measured the diameter, length, and arc of rotation of this nutritive vessel. In addition, the authors dissected six of the hands under a dissecting microscope and, after selective injection of gelatin dye solution, the authors analyzed the vessel entrances into the bones histologically. Results In all examined hands, the second dorsal metacarpal artery was a nutritive vessel to the dorsal base of the second metacarpal. The average diameter was 1.3±0.4 mm and the average length of the vascular pedicle was approximately 3.3±0.3 cm. In 14 of 16 cases, the arc of rotation was sufficient to reach the lunate without difficulty. Histologic analysis showed an intrinsic blood supply in the donor region with a vessel diameter of approximately 58 μm. A clinical case with application in Kienbock disease is presented. Conclusion Pedicled vascularized bone grafts from this area are suitable for clinical application to treat Kienbock disease if standard donor sites are unavailable.

Ziel: Ziel dieser retrospektiven Studie war es zu untersuchen, wie haufig und in welcher Form eine Medianus-Neuropathie nach perilunaren Luxationsverletzungen auftritt mit besonderem Augenmerk auf die vorausgegangene Therapie und dem langfristigen klinischen Ergebnis. Patienten und Methode: 32 Patienten wurden durchschnittlich 65 Monate (22 Monate–9,8 Jahre) nach chirurgischer Behandlung einer perilunaren Luxationsverletzung, bei 13 Patienten einschlieslich einer Karpaldachspaltung, klinisch und radiologisch nachuntersucht. Bei 10 von 11 Patienten mit klinischen Symptomen einer Me­dianus-Iirritation erfolgte zusatzlich eine elek­trophysiologische Untersuchung. Lagen 2 oder mehr pathologische Parameter vor, wurde dies als Medianus-Neuropathie gewertet. Patienten mit und ohne Medianus-Neuropathie bei der Nachuntersuchung wurden miteinander verglichen. DASH-Score, Griffkraft, Schmerzen, Handgelenksbeweglichkeit und der Mayo wrist score wurden zur Beurteilung des Ergebnisses herangezogen. Ergebnisse: Insgesamt zeigten 9 Patienten eine Medianus-Neuropathie bei der Nachuntersuchung. Bei 6 Patienten persistierte diese seit dem Unfall, bei 5 davon trotz initialer Karpaldachspaltung. 3 Patienten zeigten eine sekundare, verzogert aufgetretene Medianus-Neuropathie. Pa­tienten mit Medianus-Neuropathie hatten ein schlechteres Ergebnis hinsichtlich Griffkraft, Ruheschmerzen, dem Mayo wrist score und dem DASH-Score, hinsichtlich Belastungsschmerzen statistisch signifikant. Schlussfolgerung: Eine Medianus-Neuropathie nach perilunarer Luxationsverletzung ist haufig. Diese tritt meist nicht als typisches Karpaltunnelsyndrom, sonder vielmehr als chronischer Nervenschaden in Erscheinung. Eine primare Karpaldachspaltung kann nicht immer anhaltende neurologische Storungen verhindern.

Ziel: Vergleich der klinischen und der sonomorphologischen Befunde bei Kindern mit der Verdachtsdiagnose einer akuten Appendizitis. Methode und Patienten: Retrospektive Analyse der sonographischen und intraoperativen Befunde bei dem Patientengut der Notaufnahme der Klinik für Kinder und Jugendliche[zum vollständigen Text gelangen Sie über die oben angegebene URL], Süddeutscher Kongress für Kinder- und Jugendmedizin; 65. Jahrestagung der Süddeutschen Gesellschaft für Kinder- und Jugendmedizin gemeinsam mit der Süddeutschen Gesellschaft für Kinderchirurgie und dem Berufsverband der Kinder- und Jugendärzte e.V. – Landesverband Hessen

The operative therapy of the autonomous thyroid deals almost exclusively with nodular goiters. There are only rare situations with purely diffuse autonomy in surgical patients. The endpoint of operative therapy is permanent elimination of clinically relevant autonomous function and thereby irreversible abolition of thyrotoxicosis, even in their latent form. Clinically relevant autonomous function normally ist linked to nodular structures of different size and different distribution, so that this aim corresponds automatically with the aim of complete removal of nodular structures, both in autonomous and in non-autonomous goiters. Function is best preserved by leaving a homogenous remnant of considerable size. In different particular clinical situations (for example pregnancy, suspicion of malignancy, recurrent goiter, intrathoracic goiter, thyrotoxic crisis, Marine-Lenhart-syndrome) the basic principal of operative strategy is varied according to the respective situations. Unsatisfactory operative results are mainly caused by incomplete removal of nodules, based on insufficient surgical performance of morphological and functional diagnostics, which is related to operative uniformity. An operative strategy, which ist "fitted to morphology" and "regarding function" and which we call "selective strategy", in our opinion ist highly appropriate, to avoid remnant nodules and remnant autonomy and to preserve an normal remnant, even in different position and of different size. This selective surgery ist applicable both to autonomous and non-autonomous goiter. Compared with the classic subtotal, uniform procedure the incidence of remnant nodules is reduced from about 50% to about 5 %. Remnant autonomy is almost excluded, when mistakes are avoided (about 1%). The incidence of recurrent goiter and recurrent thyrotoxicosis is lowered to under 5%--but up to now there are too few reliable long-term follow-up studies. The selective surgery strategy demands flexibility regarding operative tactics, which can be simply classified into 5 basic situations, which we relate to the operative procedure per thyroid lobe. It requires experience and competence in carefully dissecting and--when necessary--manipulating the recurrent laryngeal nerve und the parathyroid glands. Under these conditions it is followed by a comparatively low rate of complications (permanent recurrent laryngeal nerve paralysis and hypoparathyroidism under 1%, respectively). Thus, the old dilemma of thyroid surgery can be solved, which consists of radical operation with higher morbidity and lower frequency of recurrent disease on the one hand and more limited operative procedures with fewer complications but more frequent recurrencies on the other hand.

Allergic reactions occurring after tattooing, especially after the use of red tattoo ink ingredients are relatively rare. We report a painful skin reaction occurring 6 months after the tattoing of the right lower extremity in a 30-year-old female patient. Pathohistological and immunchemical results confirmed a pseudolymphoma. Only the tangential excision of the affected areas led to a sufficient healing process. Split thickness skin grafts were used for defect coverage. 2 years later, the patient was still pain free and the wounds had healed completely without any irritation.

1.1 Hintergrund und Ziele Titan ist durch seinen langjährigen Einsatz in der Implantologie als durchaus biokompatibles Material in Bezug auf menschliches Gewebe bekannt. Es ist mit einer relativ geringen Entzündungs- und allergischen Reaktion in der Lage, eine relativ günstige Integration im Gewebe zu erlangen. Durch die Beschichtung eines Nahtmaterials mit Titan-Dioxid (TiO2) soll versucht werden, sich die in der Literatur beschriebenen positiven Auswirkungen auf die Gewebeintegration im Hinblick auf eine mögliche verbesserte Wundheilung und eventuell daraus folgende bessere Narbenreifung zu Nutze machen. Die an der Plastisch- und Handchirurgischen Klinik der Universität Erlangen-Nürnberg durchgeführte prospektive randomisierte Studie soll die Unterschiede in der Wundheilung zwischen einem titanbeschichteten Nahtfaden und einem identischen Polyamidfaden ohne Titanbeschichtung analysieren. Hierbei wurde untersucht, ob die Biokompatibilität des nicht leitenden, korrosionsbeständigen Titanoxids (TiO2) einen verminderten Ionenfluss durch das Zellgewebe sowie einen positiven Einfluss auf die mediatorbasierte Zellinteraktionen der Wundheilung verursacht. 1.2 Methode (Patienten, Material und Untersuchungsmethoden) Im Zeitraum von 01/2011 bis 07/2011 wurden insgesamt 21 gesunde Probanden mit einem Mindestalter von 18 Jahren in diese Studie eingeschlossen, bei welchen ein elektiver Eingriff an der Hand/Unterarm mit einer Mindestnahtstrecke von 4 cm an der Klinik für Plastische und Handchirurgie der Universitätsklinik Erlangen durchgeführt wurde. Die Wunden wurden in der Mitte geteilt und ein Abschnitt mit dem unbeschichteten Faden A (Seralon®, Serag-Wiessner KG) und der andere Anteil mit dem titanbeschichteten Faden B (Seratan® Serag-Wiessner KG) mit identischer Nahttechnik verschlossen und mit gleichem Verbandsmaterial versorgt. Es erfolgten zahlreiche standardisierte Nachuntersuchungen wie Vancouver Scar Scale (VSS), Patient and Observer Assessment Scale (POSAS), Cutometermessungen sowie eine verblindete Auswertung der Fotodokumentation. Die Untersuchungen erfolgten ab dem 14. postoperativen Tag in regelmäßigen Intervallen, 6 Wochen, 3 und 6 Monate und 12 Monate postoperativ. Die statistische Auswertung erfolgte durch das Institut für Medizininformatik, Biometrie und Epidemiologie der Friedrich-Alexander-Universität Erlangen-Nürnberg. 1.3 Ergebnisse und Beobachtungen Von den 21 Probanden konnten 18 (86%) vollständig untersucht werden. Bei der Fotoauswertung am 14 postoperativen Tag zeigten sich signifikant (p=0,004) weniger lokale Entzündungszeichen, ein homogeneres Narbenbild sowie signifikant bessere (p= 0,046) Werte beim VSS- Test nach 12 Monaten für den titanbeschichteten Faden. Auch bei weiteren Auswertungen wurden tendenziell bessere Resultate für Faden B gefunden, jedoch ohne statistische Signifikanz. Im zeitlichen Verlauf von 12 Monaten zeigte sich eine Annäherung bei den Untersuchungsergebnissen von Faden A an Faden B. Differenzen in Bezug auf das intraoperative „handling“ und auf die physikalischen Eigenschaften der Fäden konnten keine festgestellt werden. 1.4. Praktische Schlussfolgerungen Die durchgeführte klinische Studie zeigt, dass die Titanisierung des Nahtmaterials zu einer messbaren Verbesserung der Wundheilung und der daraus resultierenden Narbenqualität führt. Die Werte zwischen den beiden Gruppen nähern sich im Verlauf der physiologischen Wundheilung innerhalb von 12 Monaten an. Aufbauend auf diese Daten, sollten noch zusätzliche klinische Studien mit weiteren Fragestellungen initiiert werden, um unsere Ergebnisse zu verifizieren und zu ergänzen.

Einleitung: Malabsorption und Mangel an Spurenelementen sind bekannte Probleme nach bariatrischen Eingriffen. Die enterale Resorption von Calcium ist nicht nur Vitamin D sondern auch vom gastralen pH Wert abhängig. Bei Patienten, die aufgrund von Gastro ösophagealem Reflux (GERD) nach einer[for full text, please go to the a.m. URL], 132. Kongress der Deutschen Gesellschaft für Chirurgie

Hintergrund: Ziel dieser Studie ist es auf die verschieden Inzidenzen von postoperativen Komplikationen nach körperformenden Eingriffen (bodycontouring) zu analysieren. Insbesondere wird auf geschlechtsspezifischen und nach Art der Gewichtsabnahme abhängigen Parameter eingegangen. Material[for full text, please go to the a.m. URL], 45. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 19. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC), 52. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPRÄC)

The purpose of this retrospective study was to investigate the frequency and appearance of median nerve neuropathy following perilunate dislocation injuries with respect to the preceding surgical decompression and the clinical outcome.32 patients were followed for a mean of 65 months after surgery for perilunate dislocation, including carpal tunnel release in 13 patients. 10 of 11 patients with clinical symptoms of median nerve affection at follow-up had additionally an electrophysiological examination. Median neuropathy was assumed if 2 or more parameters were pathologic. Patients with and without median neuropathy were compared. The DASH score, pain, wrist motion, grip strength and the Mayo wrist score were used to rate the outcome.In 6 patients, neuropathy of the median nerve persisted since injury in spite of carpal tunnel release in 5 of them. 3 patients showed secondary, delayed median nerve affection. Patients with median neuropathy had a worse result with regard to pain at rest, grip force, the DASH score, and the Mayo wrist score. The difference was statistically significant for pain with activities.Median neuropathy following perilunar dislocation injuries is frequent. It appears rather like a chronic neural lesion than a typical compression syndrome. A primary carpal tunnel release cannot always prevent persistent neural disorders.

Hintergrund: Oberlid-Blepharoplastiken (OLB) gehören zu einer der am häufigsten durchgeführten operativen Straffungs-Operationen im Gesicht. Aufgrund der Vielzahl der Anzeichnungs- und Resektionsmöglichkeiten besteht in der Literatur eine sehr heterogene Beurteilung der Ästhetik[for full text, please go to the a.m. URL], 45. Jahrestagung der Deutschen Gesellschaft der Plastischen, Rekonstruktiven und Ästhetischen Chirurgen (DGPRÄC), 19. Jahrestagung der Vereinigung der Deutschen Ästhetisch-Plastischen Chirurgen (VDÄPC), 52. Jahrestagung der Österreichischen Gesellschaft für Plastische, Ästhetische und Rekonstruktive Chirurgie (ÖGPRÄC)

Aim To evaluate visual quality and postoperative results as well adverse events in myopic patients undergoing I-CARE anterior-chamber angle-supported phakic intraocular lens (IOL) implantation. Design A retrospective, non-randomised, case series. Participants Data on 29 eyes (16 patients) receiving I-CARE phakic IOL for high myopia (–11.66±3.3) were analysed. Methods The IOLs were implanted between 2003 and 2006 at the Department of Ophthalmology, Medical University, Graz, Austria. The mean follow-up was 51.7±16 months (17–78 months). Main outcome measures The authors measured uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA); patients underwent slit-lamp examination, corneal topography, Scheimpflug imaging and measurement of endothelial cells (EC). Results The mean UCVA and BCSVA were 0.63 and 0.94 decimal after 1 year. Endothelial cell loss was the most serious adverse event observed. The mean EC loss was 2%, 9%, 17%, 21%, 33% and 47% after 1 year (n=17), 2 years (n=20), 3 years (n=17), 4 years (n=17), 5 years (n=12) and 6 years (n=3), respectively. Eight IOL explantations were made due to severe EC loss 3–6 years after implantation. Other serious complications included one patient with Urrets–Zavalia Syndrome (one eye). Conclusion Implantation of the I-CARE phakic-IOL is not a safe method for the correction of high myopia due to serious endothelial cell loss that might occur in a high number of patients. Patients with these IOLs should be followed up at least every 6 months, and the IOL should be explanted, once the EC count drops to less than 2000 cells/mm 2 .

Einleitung: Die Ultraschallelastographie (USE) ist eine Untersuchungstechnik, die es ermöglicht, über die Bestimmung der Gewebselastizität von Schilddrüsenknoten eine präoperative, nicht invasive Dignitätsabschätzung zu erreichen. Material und Methoden: Von 2008[for full text, please go to the a.m. URL], 127. Kongress der Deutschen Gesellschaft für Chirurgie

Coverage of soft-tissue defects of the thumb, which cannot be covered primarily or with a skin graft, by a neurovascular pedicled island flap from the dorsum of the index finger.Combined skin and soft-tissue defects of the back of the hand, the thumb web space, and especially the thumb.Damages to the first dorsal metacarpal artery or the rete carpale dorsale. Previous injuries to the flap donor area. Local infection.Outlining of the skin flap design on the dorsum of the index finger. S-shaped skin incision at first web space radially. Identification of the first dorsal metacarpal artery and preparation of a fascioneurovascular pedicle for flap supply, with involvement of the fascia of the dorsal interosseous muscle in the flap pedicle. Intersection of the island flap from the index finger. Preparation and uplifting of the flap. Tunneling of the island flap under a skin bridge into the covering defect on the thumb. Fixation and suturing of the flap in the defect. Coverage of the flap defect on the dorsum of the index finger with a skin graft.Immobilization with a cast for 7 days, followed by finger mobilization and wound care.During the years 2005 and 2006, 15 major soft-tissue defects of the thumb in eleven men and four women were reconstructed using a neurovascular island flap of the first dorsal metacarpal artery. The results were comparable to those previously reported in the literature. All flaps healed completely without any complications. The two-point discrimination measured an average of 8.8 mm.

Einleitung: Die Ultraschallelastographie ist eine neue Untersuchungstechnik, die es sich zum Ziel gesetzt hat, auf non-invasivem Wege eine Abschätzung der Dignität von Herdbefunden zu erreichen. An der Schilddrüse und in der Schilddrüsenchirurgie liegen hierzu bislang keine verläßlichen[for full text, please go to the a.m. URL], 126. Kongress der Deutschen Gesellschaft für Chirurgie

Flexor tendon repair by direct suture, providing tendon function and mechanical properties and allowing postoperative active extension and flexion.Flexor tendon laceration in all zones, when primary healing and a good functional outcome can be expected.Florid and chronic infection. Lack of skill, instruments, or manpower. Tension-free suture is not feasible. Severe soft-tissue problems. Mantero suture in case of coexistent artery injury.Hand surgical incisions and approach to the tendon. Opening of the tendon sheath in the region of oblique pulley. A four-strand core suture consisting of two locked two-strand sutures and a circumferential epitendon cross-stitch suture are performed. Lacerations in zone I with a tendon stump shorter than 1 cm require a Mantero suture and avulsions require a pull-out suture technique.Active flexion and active extension in a dorsal wrist cast.The clinical outcome studies after repair of zone II flexor tendon injuries using a multiple-strand suture technique describe 69-96% excellent and good results.

In treating benign nodular goiter, selective surgery taking into account morphology and function is better than standard subtotal resection for reducing the frequency of nodules in the thyroid remnant. Intraoperative ultrasound (IOPUS) may additionally influence operative radicality and also the incidence of remaining nodules.One hundred consecutive patients with benign nodular goiter were operated on with IOPUS; the specimens were compared with results of preoperative ultrasound and intraoperative palpation. Of these patients, 80 were reinvestigated after 3+/-1.6 years. A series of 80 patients with the same operative strategy but without IOPUS was used as control group, having been reinvestigated sonographically 1 year postoperatively, and was compared to the IOPUS group with respect to operative procedures, size of remnants, and sonography of lesions in thyroid remnants.In 35% of the thyroid lobes, preoperatively undetected nodules could be identified additionally by IOPUS, which also provided information on extent and structure in a further 20%. It resulted in the indication for more radical surgery in 24% and greater tissue preservation in 10%. Compared to surgery without IOPUS, IOPUS-guided surgery was more radical (total lobectomy in 40% vs 24%, nonresected lobes in 16% vs 26%, P0.05) and showed a lower incidence of nodules in remnants at follow-up (2.5% vs 12.5%, P0.05).With IOPUS, more nodules are detectable, size and structure of the remnants are optimized, and the number of nodular lesions in thyroid remnants is lower. Thus, an even lower risk of recurrence can be expected for long-term follow-up. All in all, the routine use of IOPUS can be advocated, with maintenance of the selective operative strategy.