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General Surgery
Left Thyroid Lobectomy
Built from Atlas of Thyroid Surgery
What’s inside
5 sections · 62 slides
Case and Indications
Why this patient needs a left thyroid lobectomy
- The patient and the nodule
- The thyroid gland and its neighbours
- Thyroid anatomy
- Two reasons to remove a thyroid lobe
- Indications for thyroid lobectomy
- Preparing for a possible completion thyroidectomy (1 of 2)
- Preparing for a possible completion thyroidectomy (2 of 2)
Positioning and Exposure
Set up the field and reach the thyroid
- Sequence of exposure
- Positioning the patient
- Opening the neck
- Cervical incision and landmarks
- Cervical incision and landmarks (labelled)
- Raising the subplatysmal flaps
- Creation of superior subplatysmal flap
- Superior subplatysmal flap (labelled)
- Opening the strap muscles
- Divide the strap muscles along the midline
- Strap muscles divided at the midline (labelled)
- Separate the sternohyoid from the sternothyroid muscles
- Separating the strap muscles (labelled)
- Reaching the middle thyroid vein
- Identify the middle thyroid vein crossing over the carotid artery
- Middle thyroid vein divided and ligated (labelled)
Finding and Protecting Key Structures
RLN, pyramidal lobe, and the superior and inferior poles
- Identifying the recurrent laryngeal nerve (RLN)
- Recurrent laryngeal nerve landmarks
- Recurrent laryngeal nerve landmarks (labelled)
- Include the pyramidal lobe and pretracheal nodes
- Dissect out the pyramidal lobe and pretracheal nodal tissue
- Pyramidal lobe and pretracheal nodal tissue (labelled)
- Mobilizing the superior pole
- Avascular space of Reeves
- Avascular space of Reeves and the external branch of the superior laryngeal nerve
- Divide the superior pole vessels
- Superior pole vessel division (labelled)
- Freeing the lateral thyroid and finding the superior parathyroid
- Division of the investing fascia around the lateral edge of the superior pole
- Investing fascia division (labelled)
- Identify the superior parathyroid gland
- Mobilizing the inferior pole
- Location of the RLN and parathyroid glands
- RLN and parathyroid landmarks (labelled)
Completing the Resection
Ligament of Berry, parathyroid transplant, and closure
- Medializing the thyroid at the ligament of Berry
- RLN, ligated ligament of Berry, and anterior trachea
- Dividing the isthmus and removing the specimen
- Elevating the thyroid off the trachea
- Assessing the parathyroid glands
- Parathyroid viability decision
- Preparing the parathyroid for transplant
- Parathyroid transplant steps
- Emulsify the parathyroid
- Emulsified parathyroid tissue
- Prepare the parathyroid for reimplantation
- Transplant safety checks
- Inject the parathyroid into the SCM
- Injection into the SCM (labelled)
- Closure
Tips and Pitfalls
Lessons that make the operation safer
- Incision and exposure tips
- Protecting structures during dissection
- RLN protection and magnification
- Key points of a left thyroid lobectomy
- References
- Atlas of Thyroid Surgery