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Chapter 13
Reynaldo O. Joson, MD
1986
PAGES 106-109
Thyroidectomy How I Do It
2.0 Position
2.2 Face positioned at a midline axis with chin in line with the sternal notch
3.0 Prepping
3.1 Antiseptic prepping of the anterior and lateral aspects of the neck extending to the chin and lower
jaw superiorly and to the nipple line inferiorly
4.0 Draping
4.1.1 Two towels, one on top of the other, laid behind the head and neck
4.1.2 Top towel used to wrap around the face and secured at chin level
4.2 Four towels enclosing the neck and the planned incision
5.0 Incision
5.1 Level
5.2 Length
5.2.2 Usually from lateral border of one sternocleidomastoid muscle to the other
5.2.3 May be extended upward along the posterior border of the sternocleidomastoid muscle to
the mastoid are in case of concomitant neck dissection
5.4 Points of emphasis: adequate incision and resultant symmetrical, fine postoperative incisional scar
6.0 Flaps
7.1 Split along vertical midline between the 2 pairs of strap muscles starting from below going up. It is
easier to look for the midline just above the sterna notch. The 2 pairs of muscles diverge at this area.
7.3 If strap muscles need to be transacted for better exposure, do so at the upper third to avoid injury
to the motor nerve supply
8.1 Exploration of the whole thyroid gland and adjacent tissues by palpation and inspection
9.2 Usually, start from the inferior pole, then identify the position of the recurrent laryngeal nerve and
the parathyroid(s) from the lateral lower part of the thyroid gland along the trachea-esophageal groove,
then proceed to the superior pole
9.3 Large and medium sized vessels are ligated after transaction using non-absorbable sutures (3-0, 4-
0, or 5-0); small sutures can be cauterized.
9.4 The recurrent laryngeal nerves, the superior laryngeal nerves, and at least one parathyroid on each
side are identified and preserved as much as possible.
9.5 After mobilization of the inferior pole and the lateral aspect of the thyroid gland, the gland is
retracted medially. The tracheo-esophageal groove is identified by palpation. The recurrent laryngeal
nerve is located along the groove by creating small openings on the fibroareolar tissues adjacent to the
inferior thyroid artery. Care should be taken not to lacerate the blood vessles and compromise the
parathyroids nearby. The nerve is identified through these openings and its position noted. Do not
traumatize the nerve by pinching it with a forcep. Keep a distance away from the nerve during
dissection unless a compartmental dissection for malignancy is to be performed.
9.6 For near-total lobectomy, the tissues anterior to and adjacent to the inferior thyroid artery and the
parathyroid(s) are selected for preservation. This holds true for subtotal lobectomy unless this area is
grossly diseased. In such a situation, the superior pole is selected for preservation, if possible.
9.7 For total thyroidectomy, ensure viability of the parathyroids by preserving their blood supply. Use
sharp knife to separate thyroid tissues from the tracheal fascia.
10.0 Hemostasis
10.1 Cautery
10.3 Bleeding raw edges of a thyroid remnant after a subtotal lobectomy or subtotal
thyroidectomy may be controlled with a running chromic 4-0 suture
11.0 Drain
11.2 If required, provide wide skin opening from drain to ensure adequate drainage
12.0Wound closure
12.3 Platysmal subcutaneous approximation (absorbable suture Dexon or Vicryl 4-0 or 5-0)
13.0 Dressing
13.1Light dressing