[Effect of a modified struma resection technic on the rate of lesions of the recurrent laryngeal nerve].

Recurrent laryngeal nerve injury still remains the major problem in thyroid gland surgery and is influenced both by morphology and function of the goitre and essentially by the resection technique. Between 1982 and 1985 a total of 825 patients was operated on for the first time due to a benign goitre. In period A (Jan. 1982 to Dec. 1983) we always-- preceding the resection of the goitre--performed the ligature of the A.thyreoidea inferior (n = 412) whereas in period B (Jan. 1984 to Dec. 1985) we dispensed with it (n = 413). In neither of the two periods the preparation of the N.laryngeus recurrens--save few exceptional cases--was performed. The immediate postoperative recurrent laryngeal nerve palsy rate decreased from 4.9% in period A to 2.2% in period B, the persistent palsy rate (laryngeal control half a year postoperatively) from 2.18% to 0.48%. Due to the change to smaller, more hyperfunctional goitres in endemic areas we believe it possible to perform the resection of benign goitres without the preliminary ligature of the A.thyreoidea inferior and the preparation of the recurrent laryngeal nerve. On one hand this can lead to the facilitation of the surgical task, on the other hand to the decrease of the injury risk on the recurrent laryngeal nerve.