DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right thyroid nodule.
POSTOPERATIVE DIAGNOSIS: Right thyroid nodule.
OPERATION PERFORMED: Right hemithyroidectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
INDICATION FOR OPERATION: The patient is a (XX)-year-old woman with an enlarging mass in the right thyroid. Fine needle aspiration thus far has been indicative of benign pathology. However, because this is enlarging, we have elected to do a right hemithyroidectomy and possible total thyroidectomy based on frozen specimen and visual and palpable inspection of the thyroid gland intraoperatively.
DESCRIPTION OF OPERATION: After obtaining informed consent, the patient was taken from the holding area to the operating room by the anesthesia and surgery teams. She was placed on the operating table in the supine position. After adequate general endotracheal anesthesia by the anesthesia team with a nerve monitoring endotracheal tube, the patient was prepped and draped in the usual sterile fashion. The nerve monitoring device was connected to the patient.
A curvilinear incision was made two fingerbreadths above the sternal notch. Subplatysmal flaps were elevated superiorly and inferiorly. Strap muscles were divided along the midline. The right thyroid was visualized. The middle thyroid vein was clipped on the patient’s side and then taken down with a Harmonic scalpel on the thyroid side. Inferiorly, the thyroid was traced, and the inferior pole was elevated away from its vasculature by taking these down slowly with bipolar cautery or Harmonic scalpel.
The parathyroid gland in this area was identified and kept intact with its vasculature. The thyroid edge was then traced superiorly proceeding from inferior to superiorly. The other small veins were taken down with Harmonic scalpel along the lateral edge, and the superior lobe was elevated away from the superior vessels with bipolar cautery and Harmonic scalpel.
Once this was done, a Babcock was placed on the thyroid, and it was elevated up out of the wound. Gentle dissection in the area of the tracheoesophageal groove revealed the recurrent laryngeal nerve passing superiorly. A small nodule of the thyroid, the nodule of Zuckerkandl, was elevated away from the recurrent laryngeal nerve.
Once the entire thyroid was elevated away from the nerve, the thyroid was elevated off of the anterior tracheal wall with Bovie cautery. The Harmonic scalpel was used to come across the central portion of the isthmus. A small lymph node was taken from level 6 and sent for frozen specimen along with the thyroid. Both of these came back as not demonstrating carcinoma. The thyroid just demonstrated a follicular lesion, but it was not determined whether it was malignant at this point. The lymph node was confirmed to be a lymph node, but there was no other pathology associated with it. The inferior parathyroid was regaining good color. The superior parathyroid on this side was not visualized. The recurrent laryngeal nerve was stimulated, and the posterior cricoarytenoid muscle was palpated. There was good movement of the posterior cricoarytenoid muscle as it was palpated.
The strap muscles were closed in the midline. The platysma layer was closed with Vicryl stitching. A 5-0 Monocryl was run subcutaneously to close the skin. The patient was allowed to awaken from anesthesia and was extubated without incident and returned to the recovery room in stable condition.
