Thyroidectomy- operative surgery

THYROIDECTOMY- Operative Surgery


Dear viewers,
Greetings from “Surgical Educator”
Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries. I have already uploaded two videos on open and Laparoscopic Appendicectomy. In this video today, I have discussed Thyroidectomy Surgery. However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery. Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful. This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
Surgicaleducator.blogspot.com
Youtube.com/c/surgicaleducator
Thank you for watching the videos.

1. THYROIDECTOMY DR.B.Selvaraj MS; Mch ; FICS; Professor of Surgery Melaka Manipal Medical College Melaka 75150 Malaysia OPERATIVE SURGERY

2. THYROIDECTOMY INDICATIONS: - Thyroid malignancies - Multinodular goiter - Graves’ disease ANESTHESIA: - GA-(ET) POSITION: - Semi-fowler’s position with neck hyperextension Pre-op preparation for surgery: - Investigations like TFT, FNAC, USG thyroid, Thyroid scintigraphy and bone scan - Never use iodine containing contrasts - If patient is hyperthyroid bring to euthyroid state with anti-thyroid drugs and propranolol - Give Lugol’s iodine from 10 days prior to surgery to diminish vascularity - Exclude MEN sydromes

3. THYROIDECTOMY POSITIONING - Semi-fowler’s position - Pillow in between scapulae to hyperextend neck on a headrest - Protect eyes DRAPPING- Double towel for head - Expose cranially mandible, caudally suprasternal notch, laterally sternomastoid muscles -Silk thread to imprint incision

4. THYROIDECTOMY Skin incision & division of platysma - Kocher’s low collar incision - Subdermal platysma muscle incision Mobilisation of upper & lower flaps - Skin with platysma flaps mobilised cranially upto thyroid cartilage- upper flap - Lower flap mobilised caudally upto suprasternal notch

5. THYROIDECTOMY Ligation of anterior jugular veins - The superficial anterior jugular veins are suture ligated and divided Division of strap muscles & pretracheal fascia - Divide the strap muscles in the middle - Incise the pre tracheal fascia - Dissect laterally in between the pretracheal fascia(false capsule) and true capsule of thyroid gland

6. THYROIDECTOMY Mobilisation of lateral lobe and ligation of middle thyroid vein - Mobilise the lateral part of a lobe - Ligate and divide middle thyroid vein Exposure of superior pedicle & it’s division - Clamp, divide and transfix the superior pedicle as close to the gland as possible - Nowadays Harmonic scalpel has been used

7. THYROIDECTOMY Division of inferior thyroid pedicle - Inferior thyroid pedicle is exposed, clamped, divided and transfixed Division of inferior thyroid artery - Retract the lateral part of the lobe medially - Ligate and divide inferior thyroid artery branches individually at the surface of the gland

8. THYROIDECTOMY Separation from anterior tracheal aspect - Division of Berry’s ligament allows the thyroid to be mobilized medially - Dissection of the thyroid from the trachea can then be performed with the electrocautery For Hemithyroidectomy - If lobectomy is indicated, then the isthmus is clamped using a Kocher or tonsil clamp, divided, and oversewn with an interlocking continuous 3-0 Vicryl suture

9. THYROIDECTOMY For Total Thyroidectomy - If total thyroidectomy is indicated, the operation is continued in a similar fashion on the other side to remove the thyroid gland in toto - Preserve parathyroids and recurrent laryngeal nerves For S ubtotal Thyroidectomy - Perform a subtotal resection if operating for benign disease, thus preserving the parathyroid glands and not dissecting in the area of the recurrent laryngeal nerves. - The line of resection on the thyroid lobe to preserve this rim of thyroid tissue overlying the parathyroid glands is shown in Fig

10. THYROIDECTOMY - Once resection is completed and hemostasis is ensured, closure is performed by first reapproximating the strap muscles at the midline using interrupted 3-0 Vicryl sutures CLOSURE OF INCISION -The platysma muscle is likewise reapproximated using interrupted 3-0 Vicryl sutures -Finally , the skin is reapproximated with a subcuticular stitch of 4-0 Monocryl suture - Keeping a suction drain is surgeon’s option

11. THYROIDECTOMY COMPLICATIONS - Tension hematoma - Recurrent laryngeal nerve injury - Superior laryngeal nerve injury - Hypoparathyroidism - Hypothyroidism - Wound infection - Hypertrophied scar or keloid Recent Advances - Endoscopic Thyroidectomy: Bilateral Axillo -Breast Approach (BABA ) - Axillary port insertion and sharp dissection with Harmonic. A 12-mm port is made on the right axilla (marked by star )