[Is the use of surgical microscope justified in thyroid surgery? 10-year experience with thyroid surgery performed by...

Paralysis of the recurrent laryngeal nerve is the most disastrous complication following thyroid surgery. In order to minimize this complication, different devices have been used to identify the recurrent laryngeal nerve during surgery. The presently available devices are reviewed and we present our results with the device we used, the surgical microscope. Five hundred and seventy-three patients had thyroid surgery, 451 had benign lesions and 122 malignant. Calculated as nerves at risk, primary surgery in benign/malignant disease resulted in 0.6 per cent/3.5 per cent permanent paralysis and in recurrent and completion surgery this complication rate was 4.5 per cent/2.9 per cent. These results are pleasing but also stress that primary surgery should be radical so as to avoid completion or recurrent surgery.