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General Surgery
Total Thyroidectomy with Comprehensive Central and Lateral Neck Dissection for Differentiate
Built from Atlas of Thyroid Surgery
What’s inside
6 sections · 76 slides
Overview and Preoperative Workup
When this operation is used, how nodal spread is assessed, and which structures are at risk
- What this procedure treats
- Why lymph node spread matters
- Ultrasound features of suspicious nodes
- Needle sampling and confirmation
- Cross-sectional imaging and endoscopy
- Checking the vocal cords
- Structures at risk in the central neck
- Structures at risk in the lateral neck
Neck Levels and Fascial Anatomy
The lymph node levels, the fascial wrapping, and the evolution of functional dissection
- Neck lymph node levels
- Neck fascial layers
- The wrapping-cloth principle
- Evolution of neck dissection
- Standard dissection for N1b disease
Surgical Technique, Positioning, and Incision
The core principle, the operative sequence, patient setup, and flap elevation
- Core principle of the operation
- Sequence of the operation
- Patient position
- Patient positioning for thyroid and neck dissection
- Operative field
- Operative field boundaries and collar incision
- Skin incision and flap design
- Raising the subplatysmal flap
- Elevating the subplatysmal flap
- Completed subplatysmal flap exposure
Lateral Neck Dissection (Levels II-Vb)
Unwrapping the sternocleidomastoid, then clearing the submandibular, jugular, and supraclavicular basins
- Lateral dissection approaches
- Lateral dissection sequence
- Unwrapping the sternocleidomastoid
- Incising the fascia over the sternocleidomastoid
- Supraclavicular triangle and omohyoid
- Unwrapping the inferior belly of the omohyoid
- Completed supraclavicular triangle dissection
- Freeing the SCM's anterior and medial surfaces
- Freeing the fascia from the anterior sternocleidomastoid
- Mobilized sternocleidomastoid after fascial unwrapping
- Preparing the submandibular triangle
- Opening the submandibular triangle
- Defining the medial boundary
- Medial boundary of the lateral dissection
- Dissection of the medial boundary
- Unwrapping the superior belly of the omohyoid
- Opening the avascular plane behind the carotid sheath
- Nerves and vessels to preserve medially
- Avoiding sympathetic injury
- Dissecting level II
- Level II dissection with hypoglossal nerve
- Dissecting the spinal accessory nerve in level II
- Level IIa versus IIb
- Levels III and IV posterior boundary
- Posterior boundary of levels III and IV
- Preserving the cervical plexus in level III
- Level III and IV dissection along the fascial plane
- Completing level IV at the subclavian vein
- Phrenic nerve and thyrocervical trunk
- Completing level Vb
- Transposing the specimen in the supraclavicular triangle
- Removing the lateral neck specimen
Central Neck Dissection (Levels VI-VII)
Strap muscles, carotid exposure, the inferior laryngeal nerve, paratracheal and prelaryngeal clearance, and closure
- Central neck dissection targets
- Strap muscle dissection
- Sectioning the sternothyroid muscle
- Exposing the common carotid artery
- Exposing the common carotid artery
- Finding the inferior laryngeal nerve
- Dissecting around the inferior laryngeal nerve
- Right-side paratracheal dissection
- Paratracheal dissection and thyroidectomy
- Left-side and parathyroid preservation
- Pretracheal dissection and the thymus
- Prelaryngeal (Delphian) nodes
- Wound closure
- Final operative field after dissection
Key Points and References
What the chapter emphasizes, and the source literature
- Key points of the operation
- Why the fascial plane approach works
- References
- References
- References
- References
- Atlas of Thyroid Surgery