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General Surgery
Hemithyroidectomy with En Bloc Ipsilateral Central Node Dissection for Low-Risk Papillary an
Built from Atlas of Thyroid Surgery
What’s inside
4 sections · 41 slides
Personalized Thyroid Surgery
Balancing less trauma against oncological adequacy
- The move to risk minimization
- Lobectomy versus total thyroidectomy
- When the ATA recommends lobectomy
- Risk features that are hard to verify
- Why central node dissection matters
- The medullary thyroid cancer window
- Frozen section drives the decision
- The operation in one line
- Structures preserved during dissection
The Case
A 52-year-old patient with a right-sided thyroid nodule
- 515 pg/mL
- Preoperative plan and consent
- Operative setup
Surgical Procedure
Step-by-step hemithyroidectomy with en bloc central node dissection
- Procedure in six phases
- Patient positioning for thyroid surgery
- Marking the Kocher collar incision
- Raising the platysma flaps
- Opening the strap muscles at the linea alba colli
- Identifying and ligating Kocher's vein
- Mapping the vagus nerve
- Placing the clip electrode on the vagus nerve
- Tracing the recurrent laryngeal nerve
- Starting the central node dissection caudally
- Identifying the lower parathyroid gland
- Central node dissection along the trachea
- Severing the right lobe from the left
- Exposing the upper pole vessels and superior laryngeal nerve
- Dividing the upper pole vessels
- View of the operative field with the gland displaced
- Exposing the ligament of Berry
- Dissecting the lobe off the ligament of Berry
- Preserving the upper parathyroid gland
- High laryngeal entry of the recurrent laryngeal nerve
- The en bloc surgical specimen
- Placing the Blake drain
- Closing the strap muscles
- Closing the subcutaneous tissue
Outcome and Takeaways
Final pathology, biochemical cure, and key points
- Final pathology and recovery
- Biochemical cure
- Key takeaways
- References
- Atlas of Thyroid Surgery