Must the recurrent laryngeal nerve be identified routinely during resection of nodular goiter - A prospective randomized study

It was the purpose of this study to establish whether it is necessary to identify the recurrent laryngeal nerve intraoperatively when resecting the endemic nodular goiter. We prospectively formed two groups from 800 subtotal unilateral resections (''nerves at risk''). In group I (382 subtotal resections, 48.4 %) the nerve was not identified intraoperatively. In group II (413 subtotal resections, 51.6 %) the recurrent laryngeal nerve was routinely identified in all cases. The operative technique was standardized, giving special attention to the ''anterior lamella''. For all patients, preoperative and postoperative evaluation of the vocal cords was performed routinely. Altogether we saw 4 (0.5 %) transient vocal cord palsies: 2 in group I and 2 in group II. All 4 laryngeal nerve palsies recovered within 4 months. These data demonstrate that no benefit is gained from routine dissection of the laryngeal nerve during resection of endemic nodular goiter. Therefore the demand for obligatory intraoperative identification of the recurrent nerve is not tenable.