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General Surgery
Total Thyroidectomy and Ipsilateral Central Lymph Node Dissection for the Management of Papi
Built from Atlas of Thyroid Surgery
What’s inside
5 sections · 58 slides
Overview
- Roadmap
Indications and principles
Guidelines, technique, and pre-operative preparation
- Indications for total thyroidectomy
- Surgical options in differentiated thyroid cancer
- The technique at a glance
- Role of neural monitoring
- When to add central node dissection
- Nodal spread of papillary thyroid cancer
- Why routine central dissection helps
- Pre-operative work-up
Case presentation
A 40-year-old woman with incidental papillary thyroid cancer
- Case: a 40-year-old woman
- History and thyroid function
- Examination and ultrasound
- Biopsy confirms the diagnosis
Operative technique
Total thyroidectomy and ipsilateral central node dissection, step by step
- Operative sequence at a glance
- Positioning, tube, and marking
- Central skin crease marking
- Incision site and cervical plexus blocks
- Opening the neck
- Sub-platysmal flap creation
- Opening the midline fascia
- Dividing the strap muscles
- Mobilising the isthmus
- Mobilising the pyramidal lobe
- Dividing the thyroid isthmus
- Checking the vagus and freeing the lobe
- Vagal stimulation (V1)
- Retracting the superior pole
- Confirming the external branch of the superior laryngeal nerve
- Finding and protecting the RLN
- Retracting the inferior pole
- Exposing the recurrent laryngeal nerve
- Confirming recurrent laryngeal nerve integrity
- Freeing the lobe at the ligament of Berry
- Dividing tissue at the ligament of Berry
- Removing the central node compartments
- Central node dissection boundaries
- Dissecting around the recurrent laryngeal nerve
- Identifying involved central nodes
- Nodal packet around the recurrent laryngeal nerve
- Dividing the thyrothymic ligament
- Completing the first side, then the other
- Second vagal stimulation (V2)
- Checking for bleeding
- Oxidised regenerated cellulose for haemostasis
- Closing in layers
- Re-approximating the strap muscles
- Creating the autotransplant pocket
- Injecting parathyroid into sternocleidomastoid
- Closing the platysma
- Closing the skin
Aftercare and outcome
Medication, monitoring, and final pathology
- Medication after surgery
- Recovery and monitoring
- 25 mm
- Follow-up and treatment
- Key points
- References
- References
- Atlas of Thyroid Surgery