DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Papillary thyroid carcinoma, left isthmus nodule.
POSTOPERATIVE DIAGNOSIS: Thyroiditis.
OPERATION PERFORMED:
1. Left thyroidectomy.
2. Thyroid isthmectomy.
3. Continuous left and right recurrent laryngeal nerve monitoring.
SURGEON: John Doe, MD
ANESTHESIA: General, 10 mL of 0.5% Marcaine with epinephrine for local supplementation.
DESCRIPTION OF OPERATION: The patient was intubated with the Xomed nerve monitor endotracheal tube. The neck was prepped and draped in the usual manner after a shoulder roll was placed, and a low transverse cervical incision was made. The initial incision was deepened beyond platysma. A superior flap was developed to the thyroid notch and inferior flap to the sternal notch. Bleeders were subsequently ligated with 2-0, 3-0, and 4-0 silk suture ligatures. The left strap muscles were lifted off the left gland, and there was quite a bit of adherence because of the inflamed state of the gland. We were able to identify the lateral border. The middle thyroid vein was ligated with 4-0 silk ties and divided.
We then mobilized the left thyroid gland medially. The recurrent laryngeal nerve was identified and dissections were then carried out anterior to this. Inferior vascular bundle was doubly ligated with 2-0 silk ties and divided. The parathyroid gland in the inferior aspect was found to be kissing the inferior aspect of the left thyroid gland. We were able to separate this, and we left the parathyroid gland intact. The left upper parathyroid was noted to be behind the mid lobe of the left thyroid gland. This was also left intact. We controlled the superior vascular bundle as they entered the thyroid gland. They were doubly ligated with 2-0 silk ties and divided. The left thyroid gland was then further mobilized medially. It was quite adherent to the trachea and also to the recurrent laryngeal nerve and we slowly separated them. The gland was further mobilized medially. Small amounts of thyroid tissues were left right on the anterior surface of the trachea. There were small venous bleeders that were well ligated with 4-0 silk ties.
We then transected the specimen at the isthmus. The stump was ligated with 2-0 silk ties, and the specimen was submitted to Pathology. Because of the degree of inflammation, the dissection took approximately 2 hours. Frozen sections were noted above. At this point, we attempted to expose, so we could inspect and palpate the right thyroid gland. We lifted the right strap muscles off the right thyroid gland. The middle thyroid veins were ligated with 4-0 silk ties and divided. The nerve was identified at the base and traced toward the larynx. We then ligated the inferior vascular bundle with 2-0 silk ties x2 and then divided it. Given the negative frozen section, we felt that additional amount of specimen should be obtained to ensure that the entire isthmus was removed. Therefore, we lifted the medial aspect of the thyroid remnant off the trachea, and beyond the isthmus, the gland was transected. The stump was suture ligated with a 5-0 Prolene stitch. We then reinspected the right recurrent laryngeal nerve and the left recurrent laryngeal nerve; they were both noted to be functional.
Hemostasis was assured, and we then closed the strap muscles with running 4-0 Vicryl. The platysma was closed with interrupted 4-0 Vicryl and 5-0 Monocryl was used for subcuticular skin incision. Local anesthesia was infiltrated. The patient tolerated the procedure well. All sponge and needle counts were correct. Blood loss was minimal. The patient was taken to the recovery room extubated and in stable condition.
