Total Thyroidectomy Medical Transcription Sample
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Multinodular goiter.
2. Hashimoto thyroiditis.
POSTOPERATIVE DIAGNOSES:
1. Multinodular goiter.
2. Hashimoto thyroiditis.
OPERATIONS PERFORMED:
1. Total thyroidectomy.
2. Continuous laryngeal nerve integrity monitoring x2.5 hours.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 50 mL.
COMPLICATIONS: None.
INDICATIONS FOR OPERATION: This is a patient with compressive symptoms from a multinodular goiter with evidence of Hashimoto thyroiditis. After discussion of the risks and benefits, including alternative treatment options, the patient elected to proceed with total thyroidectomy under general anesthesia understanding the need for postoperative thyroid hormone replacement therapy. Additionally, the patient was noted to have borderline elevated serum calcium and PTH levels with plans for parathyroid exploration at the time of thyroidectomy.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position after induction and intubation per Anesthesia. The patient was intubated with 7.0 Xomed nerve integrity monitoring endotracheal tube. Direct laryngoscopy was performed to confirm accurate placement of the EMG contact electrodes of the vocalis muscles and endolarynx bilaterally. Subdermal ground electrodes were placed. All electrodes were hooked up to the nerve monitor, which was turned on and set for continuous laryngeal nerve monitoring for the remainder of the 2.5 hour procedure. Only short-acting muscle relaxant was used for intubation. No further muscle relaxant was given and no topical laryngeal anesthetic was used.
After confirming the correct patient and procedure using standard time-out technique, the neck was prepped and draped in standard sterile fashion. A horizontal skin incision was made in the previously identified skin crease. Dissection was carried down to the subplatysmal plane. The flaps were elevated and strap muscles were divided in the midline and retracted laterally on the left. There was extensive fibrosis making the surgery much more difficult than usual resulting from the underlying thyroiditis. The left lobe of the thyroid was noted to be massively enlarged. This was mobilized medially, and attention was turned to the superior pole.
The cricothyroid muscle and superior laryngeal nerve were identified medially and preserved. The integrity of the nerve was confirmed with the nerve stimulator monitor. The superior pole vasculature was taken with the Harmonic scalpel in such a way as to preserve the integrity of this nerve. This allowed better mobilization of the thyroid gland medially. The recurrent nerve was identified, its integrity confirmed with the nerve stimulator monitor. The inferior and superior parathyroid glands were noted to be grossly normal in appearance and were preserved along with their blood supply. The recurrent nerve was followed to its insertion near the cricothyroid membrane. Berry’s ligament was sharply transected. Attention was turned to the contralateral side.
Dissection on the right proceeded as described on the left. Again, the dissection was made extremely difficult due to the extensive fibrosis from the underlying thyroiditis. Specifically, the superior and recurrent laryngeal nerves were identified and preserved, and the integrity confirmed with a nerve stimulator monitor. The inferior and superior parathyroid glands were noted to be grossly normal in appearance and were preserved along with their blood supply. The recurrent nerve was followed to its insertion near the cricothyroid membrane, Berry’s ligament sharply transected, and the thyroid gland was passed off the field and sent for final histologic diagnosis. Hemostasis was obtained. The wound was closed in layers over a suction drain after the integrity of the recurrent nerves was confirmed bilaterally at 0.5 mA stimulus.
