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[Must the recurrent nerve in thyroid gland resection always be exposed? A prospective randomized study]
B Koch1, M Boettcher, N Huschitt
1Klinik für Allgemeine und Abdominalchirurgie, Klinikum der Stadt Kaiserslautern.
Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|September 1, 1996
Summary
Routine identification of the recurrent laryngeal nerve during endemic nodular goiter resection is unnecessary. This study found no difference in vocal cord palsy rates, suggesting no benefit from obligatory nerve dissection.
Area of Science:
- Endocrinology
- Surgical Oncology
- Otorhinolaryngology
Background:
- Endemic nodular goiter requires surgical resection.
- Recurrent laryngeal nerve injury is a potential complication during thyroid surgery.
- Intraoperative nerve identification is debated in specific goiter resections.
Purpose of the Study:
- To determine if routine intraoperative identification of the recurrent laryngeal nerve is necessary during endemic nodular goiter resection.
- To assess the impact of nerve identification on vocal cord palsy rates.
Main Methods:
- Prospective study of 800 subtotal unilateral thyroid resections.
- Two groups: nerve not identified (Group I, n=382) and routinely identified (Group II, n=413).
- Standardized surgical technique with focus on anterior lamella; pre- and post-operative vocal cord evaluation.
Main Results:
- Overall transient vocal cord palsy rate was 0.5% (4/800 patients).
- Two palsies occurred in Group I and two in Group II, with no significant difference.
- All vocal cord palsies resolved within 4 months.
Conclusions:
- Routine dissection of the recurrent laryngeal nerve offers no discernible benefit in endemic nodular goiter resection.
- Obligatory intraoperative identification of the recurrent laryngeal nerve is not supported by these findings.
- Surgical approach prioritizing other technical aspects may be sufficient.