Articles
About
Publish
Subscribe
Sign In
Title
1. Introduction
2. Pre-op Prep
chevron_right
a. A Note on Nerve Monitoring
b. Mark Incision While Patient is Awake and Can Move Neck to Better Find Crease
c. Position Patient Supine with Arms Tucked and Neck Extended
d. Pre-op Ultrasound to Confirm Incision over Isthmus and to Examine Thyroid
e. Prep and Drape Patient
3. Incision
4. Exposure of Thyroid Gland and Overlying Strap Muscles
chevron_right
a. Subplatysmal Flaps
b. Separate Strap Muscles
c. Expose Upper and Lower Borders of the Isthmus with the Trachea and Cricothyroid Muscle
5. Left Thyroid Dissection
chevron_right
a. Upper Pole Dissection and Blood Supply Ligation with Preservation of the External Branch of the Superior Laryngeal Nerve via Nerve Monitor
b. Rotate Thyroid Medially and Ligate Middle Thyroid Vein
c. Lower Pole Dissection with Preservation of Left Inferior Parathyroid Gland
d. Rotate Thyroid Medially into the Wound and Identify the Recurrent Laryngeal Nerve Within the Tracheoesophageal Groove
e. Carefully Separate Recurrent Laryngeal Nerve from Thyroid with Nerve Monitoring and Preservation of Left Superior Parathyroid Gland
f. Leave Small Thyroid Remnant Where Recurrent Laryngeal Nerve Inserts into Larynx, Which is Often Prudent in Setting of Inflammation to Prevent Nerve Traction Injury
g. Divide Attachments of Thyroid to Trachea to Complete Left Side
6. Summary of Left Side and Confirmation of Intact Recurrent Laryngeal Nerve and Viable Parathyroid Before Proceeding with Right Side
7. Right Thyroid Dissection
chevron_right
a. Separate Sternothyroid Muscle from Thyroid
b. Upper Pole Dissection and Blood Supply Ligation with Preservation of the External Branch of the Superior Laryngeal Nerve via Nerve Monitor
c. Rotate Thyroid Medially for Middle Thyroid Vein Ligation and for Lower Pole Dissection with Preservation of Right Inferior Parathyroid Gland
d. Rotate Thyroid Medially into the Wound and Identify the Recurrent Laryngeal Nerve Within the Tracheoesophageal Groove and the Right Superior Parathyroid Gland
e. Carefully Separate Recurrent Laryngeal Nerve from Thyroid with Nerve Monitoring and Preservation of Right Superior Parathyroid Gland
f. Leave Small Thyroid Remnant Where Recurrent Laryngeal Nerve Inserts into Larynx, Which is Often Prudent in Setting of Inflammation to Prevent Nerve Traction Injury
g. Divide Attachments of Thyroid to Trachea to Complete Total Thyroidectomy
8. Specimen Orientation for Pathology
9. Final Inspection, Irrigation, and Hemostasis with Valsalva from Anesthesia and Surgicel
10. Closure
chevron_right
a. Sternohyoid Muscle with 4-0 Vicryl Interrupted Sutures
b. Release Neck Extension and Close Platysma with 4-0 Vicryl Interrupted Sutures
c. Deep Dermal Layer to Take Tension off the Skin
d. Skin with Running, Knotless 5-0 Monocryl Subcuticular Suture and Steri-Strips
11. Post-op Remarks
jkl keys enabled
Open Total Thyroidectomy for Graves’ Disease
Allison S. Letica-Kriegel, MD, MSc
;
Antonia E. Stephen, MD
Massachusetts General Hospital
Tags:
General Surgery
Main Text
Procedure Outline
Transcript
Comments
Comments (0)
Subscribe to comments
LIMITED ACCESS
To gain temporary access for evaluation purposes, please:
CREATE AN ACCOUNT
OR
SIGN IN
Share This Article
Authors
Allison S. Letica-Kriegel, MD, MSc
Antonia E. Stephen, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
2/28/2025
Article ID
461
Production ID
0461
Volume
2025
Issue
461
DOI
https://doi.org/10.24296/jomi/461