[Standardized morphology-adjusted resection in treatment of benign nodular struma]

In 1996 we performed a prospective study with 279 patients suffering from benign nodular goiter. The study investigates the influence of a standardized morphologically adjusted resection technique--SMART--on complication rates in surgery. Apart from the number of transient and permanent recurrent laryngeal nerve lesions and hypocalcemia, we focused in particular on the rate of "false relapses" associated with residual nodular tissue after resection. Bilateral ligation of the inferior thyroid artery in a bilobal approach as well as the entire preparation towards the ligament of Berry permit a reduction in irreversible nerve lesions in all lobal resections to 0.4% and permanent hypocalcemia to 0.3%. Bilateral ligation of the inferior thyroid artery results in a significantly larger number of transient hypocalcemia, without any impact on the long-term course. By applying a standardized surgical technique, a residual nodular goiter rate of 1.4% can be achieved. In spite of thorough intraoperative exploration, false relapses cannot completely be ruled out, however. Nodular tissue might remain undetected by conventional intraoperative exploration even in the presence of sophisticated preoperative ultrasound of the thyroid gland. Also, performing an enucleation can lead to remaining nodules, particularly in the posterior areas. For the future intraoperative ultrasound may be an interesting method in these doubtful cases.