← All decks
General Surgery
Right Thyroid Lobectomy
Built from Atlas of Thyroid Surgery
What’s inside
6 sections · 80 slides
Overview
- Extent of a right thyroid lobectomy
- Surgical priorities, in order
- Outpatient thyroid surgery pathway
- Antibiotics for thyroid surgery
Anatomical Considerations
Nerves, vessels, and landmarks that guide safe dissection
- Right recurrent laryngeal nerve anatomy
- Nonrecurrent laryngeal nerve anatomy
- Two forms of the right laryngeal nerve
- RLN branching and motor fibers
- Inferior thyroid artery and the RLN
- Tubercle of Zuckerkandl
- Parathyroid gland locations
- Instruments set
- Instruments for thyroid lobectomy
Patient, Preparation, and Positioning
The case, intubation, positioning, and draping
- Patient's case
- Positioning and intubation
- Prepping and draping the field
Procedure Step by Step
Nine stages from skin incision to closure, shown with operative photographs
- The operation in five phases
- Skin incision and flap creation
- Skin mark and incision placement
- Skin incision in the natural skin fold
- Platysma divided at the midline
- Inferior subplatysmal flap
- Superior subplatysmal skin flap
- Strap muscles exposed at the midline
- Strap muscles split along the linea alba
- Mobilizing the lobe and middle thyroid vein
- Lateral mobilization of the thyroid lobe
- Division of the middle thyroid vein
- Controlling the superior pole vessels
- Superior pole retracted inferiorly
- Avascular space of Reeve
- Superior pole vessels elevated
- Superior pole vessels transected
- Superior laryngeal nerve (EBSLN) monitoring
- Superior pole vessel transection
- Preserving the inferior parathyroid gland
- Inferior pole retracted medially
- Inferior parathyroid gland preserved
- Identifying the right RLN
- Dissecting and protecting the RLN
- Right RLN identified and stimulated
- RLN dissected to its insertion
- RLN integrity confirmed
- RLN freed beside the trachea
- Inferior pole attachments divided
- Tubercle of Zuckerkandl dissected
- Tunnel space created above the RLN
- Fibrous tissue over the RLN opened
- Tunnel opened over the RLN
- Preserving the superior parathyroid gland
- Superior parathyroid gland separated from the tubercle
- Superior parathyroid gland preserved
- Transecting Berry's ligament
- Space created under Berry's ligament
- Berry's ligament separated from the trachea
- Berry's ligament divided
- Removing the lobe with the isthmus
- Superior thyroid attachments divided
- Inferior thyroid attachments divided
- Thyroid isthmus transected
- Muscle and skin closure
- Strap muscles approximated
- Wound after strap muscle closure
- Platysma closed
- Skin closed with running Monocryl
- Dermabond applied
- After surgery
Surgical Pearls
Practical points that reduce complications
- Pearls: imaging and preparation
- Pearls: keeping a bloodless field
- Pearls: nerve and gland protection
Management of Complications
Hematoma, hypocalcemia, and RLN injury
- Acute postoperative hematoma
- Delayed hematoma or seroma
- Postoperative hypocalcemia
- RLN injury: consequences
- Mechanism of RLN traction injury
- Complete RLN transection: repair options
- References
- References
- References
- Atlas of Thyroid Surgery