[Surgery of euthyroid nodular goiter: special considerations in surgery of recurrent struma]

Indications for surgery need individual risk-analysis. Operative strategy is more conservative with unilateral procedures, more radical with total lobectomy. The crucial risk is recurrent laryngeal nerve paralysis (r.l.n.p.). In 434 operations with 647 nerves at risk (1985-2001) we classified the anatomical situation of the nerve prospectively: X: not identified, A: not in scar and B: within scar (B1, B2 and B3 dorsally, laterally or ventrally). The risk of r.l.n.p. increased from types A to type B to X, and from B1 to B3. Up to now, intraoperative neuromonitoring did not reduce this risk, additionally.