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General Surgery
Left Thyroid Lobectomy and Isthmusectomy
Built from Atlas of Thyroid Surgery
What’s inside
3 sections · 61 slides
Overview
- Procedure at a glance
Principles
Why open thyroidectomy, and the rationale for this low-cost technique
- Open thyroidectomy
- Recurrent laryngeal nerve monitoring
- Hemostatic options
- This chapter's technique
Operative Steps
The case, positioning, and the operation in sequence
- Case presentation
- Positioning and time-out
- Neck layers opened to reach the thyroid
- Incision planning
- Skin crease marking for the incision
- Opening the skin and platysma
- Dividing the subcutaneous tissues and platysma
- Subplatysmal plane after platysma division
- Raising subplatysmal flaps
- Inferior subplatysmal flap
- Exposure with a spring retractor
- Spring retractor with protected skin edges
- Exposing the trachea
- Exposing the trachea below the isthmus
- Trachea at the inferior border of the isthmus
- Dividing the isthmus
- Dividing the isthmus from the right lobe
- Isthmus divided at the right lobe junction
- Mobilizing the left lobe
- Reflecting strap muscles and mobilizing the lobe
- Left lobe mobilized medially
- Superior pole: exposure
- Grasping the superior pole
- Superior pole lifted for vessel exposure
- Protecting the external branch of the superior laryngeal nerve
- Protecting the external branch of the superior laryngeal nerve
- Controlling the superior pole vessels
- Double-clipping the superior pole vessels
- Superior pole vessel dissection
- Dividing tissue below the superior pole clips
- Preserving the parathyroid glands
- Sweeping tissue off the capsule to preserve parathyroids
- Parathyroid preservation plane
- Identifying the recurrent laryngeal nerve
- Tracing the recurrent laryngeal nerve inferiorly
- Exposing the recurrent laryngeal nerve
- Dissecting the lower pole
- Clipping the lower pole attachments
- Lower pole freed to the level of the trachea
- Leaving a tiny remnant
- Leaving a small remnant near the nerve
- Remnant left in the adherent zone
- Removing the specimen and right lobe hemostasis
- Removing the isthmus and pyramidal lobe
- Specimen freed off the trachea
- Cautery on the cut edge of the right lobe
- Hemostasis at the right lobe cut edge
- Closing in layers
- Closing the strap muscles and cervical fascia
- Reapproximating the platysma
- Subcuticular skin closure with Steri-Strips
- Recovery and outcome
- Structures preserved during the operation
- Key points of the technique
- Suggested reading
- Atlas of Thyroid Surgery