THYROIDECTOMY

Operative Technique

Patient supine under General Anesthesia

Head and neck extended by placing a shoulder pad

Asepsis and antisepsis technique

Sterile drapes placed

Low collar incision made, placed at a level 2 fingerbreadths above the sternal notch, extending just beyond anterior borders of sternocleidomastoid muscles, incision made from skin through platysma

Superior and inferior subplatysmal flaps created, with the Superior flap dissected to the level of the thyroid cartilage and the Inferior flap to the level of the suprasternal notch

Flaps secured by temporary sutures

Midline identified, incision made through the cervical fascia in the midline

Strap muscles elevated from thyroid capsule using blunt dissection. Sternohyoid first then the sternothyroid laterally.

Middle thyroid vein identified by retracting thyroid lobe anteromedially and strap muscles laterally, middle thyroid vein divided and ligated

Superior thyroid pole identified

Superior pole vessels individually identified, skeletonized and doubly ligated.

External laryngeal nerve identified and preserved

Superior parathyroid gland dissected away from thyroid gland

Inferior thyroid artery identified and ligated. Used as a guide to locate recurrent laryngeal nerve.

Recurrent laryngeal nerve followed in a cephalad direction up to the inferior cornu of the thyroid cartilage, the point near which the nerve enters the larynx.

Lower pole of the thyroid lobe dissected.

Inferior parathyroid glands separated from thyroid gland

Inferior thyroid veins ligated

Posterior aspect of the thyroid lobe exposed fully

Subtotal Thyroidectomy

(Total Lobectomy; Isthmectomy)

after following all steps above, identifying both parathyroid glands and recurrent laryngeal nerve, all of which left in their normal locations

Posterior lobe exposed until the anterior surface of the trachea has been reached

Hemostats applied at the isthmus

Isthmus transected serially

Remaining lobe sutured with continuous chromic 4.0

Total Thyroidectomy

same steps followed on the contra lateral side as previously done

Carefully identifying parathyroid glands, recurrent laryngeal nerves, and external laryngeal nerves on both sides.

Closure

NSS wash

Hemostasis

Complete sponge count

Cervical fascia reapproximated by continuous running chromic 4.0

Platysma reapproximatted using vicryl 4.0 interrupted sutures

Subcutaneous tissue closed using chromic 4.0 interrupted sutures

Skin closed cubcuticularly using vicryl 5.0 sutures.

Betadine paint

Dry sterile dressing placed