[Identification of the recurrent laryngeal nerve and parathyroids in thyroid surgery]

Subtotal thyroid resection in the case of benign goiter carries a high risk of recurrence. The relatively high rate of postoperative cancer findings also leads frequently to secondary completion thyroidectomy. Internationally therefore the paradigm has shifted from subtotal resection to extended or total thyroidectomy, which shifts the risk to the vocal cords and parathyroids, where as a rule complications are much worse than those to the thyroid. The main surgical goal therefore is avoiding as far as possible recurrent laryngeal nerve palsy and disturbances to parathyroid function following extended resection. With adequate training and technical intraoperative aids for preserving anatomy and function of the vocal cords (neuromonitoring) and parathyroids (parathyroid hormone monitoring) the risk of complications after extended resection is not significantly higher than after classic subtotal resection without identification of the nerve and parathyroids.