[Selective (= morphology and function dependent) surgery of nodular struma: relationship to risk of recurrent laryngeal nerve paralysis by dissection and manipulation of the nerve].

In a consecutive series of 1,143 first operations for benign nodular goiter with 1,928 "nerves at risk", the incidence of postoperative recurrent laryngeal nerve palsy (RLNP) was analyzed related to the extent of the operative procedure (node-excision up to lobectomy) and manipulation of the nerve (identification, mobilization, non-identification). The incidence of early RLNP increased with the extent of the operation (1.2% up to 4.8% in lobectomy) and with the extent of nerve manipulation (up to 3.1% in extensive mobilization). However, the rate of permanent RLNP was higher after non-identification of the nerve (0.6% vs 0%), especially in the group of conventional subtotal resection (1.3% vs 0%; p < 0.05). As a rule, the nerve should be identified, especially in conventional subtotal resection, when possible without further mobilizing manipulations.