There is a not so famous saying - Nerve not seen is nerve preserved??
Stay close to the thyroid and the nerve is automatically saved.
Enthusiastic nerve identification leads to neuropraxia if not permanent damage!!!
The delicate surgical technique identifying and exposing the whole course and branches of the RLN during total thyroidectomy increased the rate of temporary hypocalcaemia and parathyroid gland autotransplantation, but decreased the rate of total permanent major postoperative complications and prevented RLN injury, so total thyroidectomy is safer with identification of recurrent laryngeal nerve.
As you mentioned, the more you get close to the thyroid gland during thyroidectomies, the more you might prevent postoperative complications including hypocalcemia, seroma formation, and recurrent laryngeal nerve damage. However, based on personal experience and with taking experts point of view into consideration, it is suggested to search the nerve till you find it and preserve it confidently unless you use novel techniques and instruments such as neurometers to indicate the nerve pathway.
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