[Prevention of recurrent nerve paresis and parathyroid lesions in thyroidectomy]

At present the risk of a post-operative nerve lesion or of hypothyroidism occurring after surgery of the thyroid still exists. Those surgeons who expose the entire length of the nerve are few but they obtain the lowest rate of post-operative vocal cord palsy. In a series of a 100 patients undergoing thyroid surgery, the nerves were visually exposed along their entire length. A nerve stimulator was used to facilitate recognition and identification. During electrical stimulation, spasmodic contractions of the larynx could be observed behind the crico-thyroid muscle, close to the ligatures of the superior thyroid vessels. The lobe was freed as for a total lobectomy. During this procedure, due to their anatomical relations, the parathyroid glands are unendangered as only the vessels which reach the thyroid itself are ligated. The safety of this operative technique was demonstrated by the absence of either nerve lesions or hypoparathyroidism in this series of 100 patients. The ensuing security allows modification of the surgical technique or procedure according to the situation. For all solid cold nodules total lobectomy is unequivocably indicated. In Graves' disease and endemic goitre the classical subtotal thyroidectomy is replaced by total lobectomy on one side and subtotal lobectomy on the other.