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General Surgery
Total Thyroidectomy (Ch 5)
Built from Atlas of Thyroid Surgery
What’s inside
6 sections · 68 slides
Overview
- Total thyroidectomy at a glance
- The operation in stages
Case and Indication
A healthy 32-year-old man with a TIRADS 5 thyroid nodule
- Case presentation
Setup and Exposure
Positioning, incision, and subplatysmal flaps
- Positioning and incision planning
- Beach-chair positioning and neck extension
- Infiltration of local anesthesia
- Division of the skin and platysma
- Elevating the subplatysmal flaps
- Elevation of the superior subplatysmal flap
- Opening the midline
- Division of the median raphe
- Freeing the strap muscle from the thyroid
Right Lobe Dissection
Vessels, parathyroids, the recurrent laryngeal nerve, and the isthmus
- Opening the box
- Exposure of the right thyroid lobe
- Retraction and medial rotation
- Manual compression and eversion
- Eversion of the lobe
- Dividing the blood supply
- Ligation of the middle thyroid vein
- Division of the lateral attachments
- Parathyroid marking and the superior pole
- Marking the right inferior parathyroid
- Tubercle of Zuckerkandl
- Mobilizing the tubercle of Zuckerkandl
- Parathyroid anatomy and preservation
- Identifying the right inferior parathyroid
- Parathyroid glands in situ
- Identifying the right superior parathyroid
- Parathyroid autotransplant sequence
- Harvested parathyroid gland
- Mincing the parathyroid
- Minced parathyroid before reimplantation
- The recurrent laryngeal nerve
- The right recurrent laryngeal nerve and its branches
- Dividing the ligament of Berry
- Dissection of the ligament of Berry
- Sharp division of the ligament of Berry
- Isthmus, pyramidal lobe, and thyroidea ima
- Division of the pyramidal lobe attachments
- Ligation of the thyroidea ima vessels
- Dissection along the anterior trachea
- Reviewing the exposed anatomy
- Right nerve and parathyroids
Left Lobe and Specimen
The contralateral lobe, the “vein of doom”, and hemostasis
- Turning to the left lobe
- The left “vein of doom”
- Dividing the left vascular bundle
- Identifying the left recurrent laryngeal nerve
- Left nerve in view
- Ligation of the left ligament of Berry
- Inspecting the specimen and hemostasis
- Inspection of the resected thyroid
- Inspecting for hemostasis
- Checking the field
Closure and Aftercare
Three-layer closure, perioperative screening, and postoperative monitoring
- Closing the neck
- Three-layer closure
- Closure of the median raphe
- Closure of the platysma
- Closed wound with wound closure strips
- Preoperative screening and vitamin D
- Nerve monitoring and vocal cord checks
- Postoperative monitoring and hematoma
- Calcium and antibiotic plan
- Calcium management after total thyroidectomy
- Postoperative instructions
- 45 min
- Surgical safety principles
- Suggested Reading
- Atlas of Thyroid Surgery