OPERATIVE SURGERY

THYROIDECTOMY
DR.B.Selvaraj MS; Mch; FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia
 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
 THYROIDECTOMY
• POSITIONING • DRAPPING- Double towel for head
- Semi-fowler’s position -Expose cranially mandible,

- Pillow in between scapulae to caudally suprasternal notch, laterally

hyperextend neck on a headrest sternomastoid muscles
- Protect eyes
-Silk thread to imprint incision
 THYROIDECTOMY
• Skin incision & division of • Mobilisation of upper & lower flaps
platysma - Skin with platysma flaps mobilised
- Kocher’s low collar incision cranially upto thyroid cartilage- upper flap
- Subdermal platysma muscle - Lower flap mobilised caudally upto
incision suprasternal notch
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• Ligation of anterior jugular • Division of strap muscles &
veins pretracheal fascia
- The superficial anterior jugular - Divide the strap muscles in the middle
veins are suture ligated and divided - Incise the pre tracheal fascia
- Dissect laterally in between the
pretracheal fascia(false capsule) and true
capsule of thyroid gland
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• Mobilisation of lateral lobe • Exposure of superior pedicle & it’s
and ligation of middle thyroid division
vein - Clamp, divide and transfix the superior
- Mobilise the lateral part of a lobe pedicle as close to the gland as possible
- Ligate and divide middle thyroid - Nowadays Harmonic scalpel has been
vein used
 THYROIDECTOMY
• Division of inferior thyroid • Division of inferior thyroid artery
pedicle - Retract the lateral part of the lobe
- Inferior thyroid pedicle is exposed, medially
clamped, divided and transfixed - Ligate and divide inferior thyroid artery
branches individually at the surface of the
gland
 THYROIDECTOMY
• Separation from anterior • For Hemithyroidectomy
tracheal aspect - If lobectomy is indicated, then the
- Division of Berry’s ligament isthmus is clamped using a Kocher or
allows the thyroid to be mobilized
medially tonsil clamp, divided, and oversewn with
- Dissection of the thyroid from the an interlocking continuous 3-0 Vicryl
trachea can then be performed with suture
the electrocautery
 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 Subtotal 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
 THYROIDECTOMY
CLOSURE OF INCISION

- Once resection is -The platysma muscle is -Finally, the skin is

completed and likewise reapproximated reapproximated with a
hemostasis is ensured, subcuticular stitch of
closure is performed by using interrupted 3-0
first reapproximating Vicryl sutures 4-0 Monocryl suture
the strap muscles at the - Keeping a suction
midline using drain is surgeon’s
interrupted 3-0 Vicryl
sutures option
 THYROIDECTOMY
• COMPLICATIONS • Recent Advances
- Tension hematoma - Endoscopic Thyroidectomy: Bilateral
Axillo-Breast Approach (BABA)
- Recurrent laryngeal nerve injury
- Axillary port insertion and sharp
- Superior laryngeal nerve injury dissection with Harmonic. A 12-mm port is
- Hypoparathyroidism made on the right axilla (marked by star )
- Hypothyroidism
- Wound infection
- Hypertrophied scar or keloid