RIGHT THYROID LOBECTOMY
– PR THYROID LOBECTOMY,UNILAT
PARATHYROID AUTOTRANSPLANT*
Description of Procedure: In the supine position with appropriate monitoring she received general endotracheal anesthesia with IV antibiotic. Shoulder roll was placed. The neck is gently extended, the neck and chest widely prepped with chlorhexidine and draped after 3 minutes. A standard Coller incision made, deepened through skin and adipose tissue with cautery dividing platysma, upper and lower flaps are created. The midline raphae is displaced to the left, identified and opened. The thinned sternohyoid muscle retracted laterally, the SCM muscle is also exposed, somewhat thinned by the mass. We elevate and separate the flimsy attachments with direct vision using Harmonic Focus. The upper pole is released quite high, dividing directly on the gland with Harmonic Focus. The upper pole is retracted medially and elevated, separating soft tissue with a Kitner dissector. I now recognized the right superior parathyroid gland, and submitted for frozen section. The remainder is minced into 1 mm cubes placed in a saline gauze. When frozen section returns confirmatory, we cease operation, make to avascular pockets in the anterior SCM and placed 4 and 5 cubes into each of the pockets, covered with horizontal 40 polypropylene suture. Return to the thyroid with elevation the course of the recurrent nodule nerve is identified, a very prominent tortuous artery is inadvertently cut and secured with a clip, this is slightly caudal to the identified and protected recurrent laryngeal nerve. Just to the right and inferior of this artery is the right inferior parathyroid gland marked with a suture. With the nerve and parathyroid recognized, we used the Harmonic Focus to separate and divide tissues off the ligament of Berry, off the anterior trachea, taking the inferior pole directly on the gland including the vessels. The isthmus is released at its junction with the otherwise normal left side and divided with Harmonic Focus. The oriented specimen is submitted. We have irrigated with saline with clear return. Blood loss from the arterial disruption and during dissection of the large mass was about 20 mL. We placed Fibrillar sheets to minimize blood accumulation and place a 10 French channel drain to exit inferolaterally held with silk. We inspected for any active bleeding and none found and now reapproximate the midline with running lock 4-0 Vicryl suture. Platysma was closed with simple running 4-0 suture, skin with running subcuticular technique. Dermal glue and dressing are applied. She is awakened and extubated in the operating suite, transported to PACU.
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