Total thyroidectomy

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Surgeon: Denise Carneiro-Pla, M.D.

Asst.: Your name

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Description of procedure: Patient was brought to the operating room and timeout was
performed. After placement of the endotracheal tube with the nerve monitor which was
confirmed to be in correct positioning with the bronchoscope, a small transverse incision
was opened in the inferior portion of her neck at the level of one of the natural creases.
The platysma was divided with the Bovie and the skin flaps were elevated superiorly
and inferiorly. The midline was divided on avascular plane and the strap muscles were
retracted laterally on the right side and the thyroid was retracted medially. Using blunt
dissection the thyroid was dissected from the surrounding structures. The nerve
monitor was used to confirm the correct position by stimulation the vagus. The entire
dissection was performed using the nerve monitor evaluating the nerve function while
dissecting the surrounding tissues. We then proceeded with a ligation of the inferior
and superior pole vessels using double medium clips. The smaller vessels were ligated
with small clips. The nerve was visualized and preserved as well as both parathyroids
glands. After hemostasis was obtained and no bleeding was present under Valsalva
maneuver, we proceeded with excision of the left lobe. The isthmus was divided with a
Bovie and sent to the back table and to pathology for permanent section. The left
thyroid lobe was excised in the exact same fashion with preservation of the recurrent
laryngeal nerve and both parathyroids glands. After assuring that no bleeding was
present bilaterally, Surgicel was placed on the thyroid bed and the midline was closed
using continuous stitches using 4-0 PDS. The platysma was approximated with
separate stitches using 4-0 PDS and the skin was closed, after the edges were excised,
using 5-0 Monocryl with subcuticular stitches. Dermabond was placed followed by half-
inch Steri-Strips. This patient was then awakened sent to recovery room in stable
condition. I was attending present throughout the entire procedure.