THYROIDECTOMY
Operative Technique
Ø Patient supine under General Anesthesia
Ø Head and neck extended by placing a shoulder pad
Ø Asepsis and antisepsis technique
Ø Sterile drapes placed
Ø 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
Ø 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
Ø Flaps secured by temporary sutures
Ø Midline identified, incision made through the cervical fascia in the midline
Ø Strap muscles elevated from thyroid capsule using blunt dissection. Sternohyoid first then the sternothyroid laterally.
Ø Middle thyroid vein identified by retracting thyroid lobe anteromedially and strap muscles laterally, middle thyroid vein divided and ligated
Ø Superior thyroid pole identified
Ø Superior pole vessels individually identified, skeletonized and doubly ligated.
Ø External laryngeal nerve identified and preserved
Ø Superior parathyroid gland dissected away from thyroid gland
Ø Inferior thyroid artery identified and ligated. Used as a guide to locate recurrent laryngeal nerve.
Ø 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.
Ø Lower pole of the thyroid lobe dissected.
Ø Inferior parathyroid glands separated from thyroid gland
Ø Inferior thyroid veins ligated
Ø Posterior aspect of the thyroid lobe exposed fully
Subtotal Thyroidectomy
(Total Lobectomy; Isthmectomy)
Ø after following all steps above, identifying both parathyroid glands and recurrent laryngeal nerve, all of which left in their normal locations
Ø Posterior lobe exposed until the anterior surface of the trachea has been reached
Ø Hemostats applied at the isthmus
Ø Isthmus transected serially
Ø Remaining lobe sutured with continuous chromic 4.0
Total Thyroidectomy
Ø same steps followed on the contra lateral side as previously done
Ø Carefully identifying parathyroid glands, recurrent laryngeal nerves, and external laryngeal nerves on both sides.
Closure
Ø NSS wash
Ø Hemostasis
Ø Complete sponge count
Ø Cervical fascia reapproximated by continuous running chromic 4.0
Ø Platysma reapproximatted using vicryl 4.0 interrupted sutures
Ø Subcutaneous tissue closed using chromic 4.0 interrupted sutures
Ø Skin closed cubcuticularly using vicryl 5.0 sutures.
Ø Betadine paint
Ø Dry sterile dressing placed