Thyroidectomy Technique

Fig. 18.1

Marking of the neck

Incision is usually 2 cm above the sternal notch.

When asleep, position the patient supine with a gel roll under the shoulders extending the neck.

Prep the entire neck to the mandible and laterally to the anterior border of trapezius. Inferiorly clean to the sternal notch.

Thyroidectomy Technique

Approach to Thyroid Gland

Infiltrate the incision area with 1:200,000 adrenaline + Marcaine to give some hydrodissection, hemostasis, and postoperative anesthesia.

Raise superior and inferior skin flaps in a sub-platysmal plane to the level of the hyoid superiorly and the suprasternal notch inferiorly.

Secure flaps either with sutures or a self-retaining retractor (Joll’s).

The strap muscles may be separated in the midline (which is a bloodless plane) or divided and retracted. If divided, this is best done deep to sternohyoid, dividing just sternothyroid, allowing access to the upper pole and minimizing the risk of damage to the EBSLN.

Dissection may involve sharp dissection, bi-/monopolar diathermy, harmonic scalpel, or a combination of these according to personal/local preferences and training.

Dissection of the Thyroid Gland

Enter the paracarotid tunnel and divide the middle thyroid vein.

It is often best to start dissection at the superior pole, individually ligating and dividing the vessels.

Mobilize the superior pole, exploring Joll’s triangle (formed by the midline, strap muscles, and superior pedicle) and identifying and preserving the EBSLN.

Care should be taken with the posterior branches of the superior thyroid artery as ligation of these may compromise blood supply to the superior parathyroid gland.

For the inferior pole, elevate the muscle and fascia and then individually ligate and divide the inferior thyroid vessels before mobilizing the gland from the anterior surface of the trachea.

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