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General Surgery
Thyroid Lobectomy
Built from Atlas of Thyroid Surgery
What’s inside
7 sections · 56 slides
Overview
- Thyroid lobectomy, step by step
Indications and rationale
When a lobectomy is chosen and why preserving the lobe helps
- Indications for thyroid lobectomy
- Why preserve the thyroid lobe
- The case
Positioning and exposure
Anesthesia, patient positioning, prep, and draping
- Anesthesia and airway
- Positioning the patient
- Patient positioning
- Preparing and draping the field
- Patient draping
- Instruments and the safety pause
- Surgical instruments
Incision, flaps, and midline
Planning the incision, raising flaps, opening the midline, and dividing the isthmus
- Planning the incision
- Incision landmarks
- Making the incision and entering the flap plane
- Layers of the neck in flap dissection
- Raising the superior and inferior flaps
- Superior subplatysmal flap
- Inferior subplatysmal flap
- Opening the midline raphe
- Opening the median raphe
- Exposing the isthmus, larynx, and trachea
- Prelaryngeal and pretracheal spaces
- Dividing the thyroid isthmus
- Mobilizing the isthmus
- Dividing the isthmus
Lateral and superior pole dissection
Following the carotid, dividing the middle thyroid vein, and freeing the upper pole
- Exposing the carotid and middle thyroid vein
- Exposing the middle thyroid vein
- Why the carotid artery is a safe guide
- Checking the nerve monitor
- Opening the upper pole
- Retracting the upper pole
- Opening the space of Joll
- Protecting the superior laryngeal nerve
- Ligating the upper pole vessels
Nerve, parathyroid, and lobectomy
Finding and protecting the RLN and parathyroid glands while removing the lobe
- Rotating the lobe to expose key structures
- Rotating the thyroid medially
- Finding the recurrent laryngeal nerve
- Dissecting along the recurrent laryngeal nerve
- The inferior thyroid artery and the nerve
- Dividing the inferior pedicle
- Dividing the inferior pedicle
- Dropping the parathyroids off the capsule
- Preserving the parathyroid glands
- Freeing the lobe at the ligament of Berry
- Dissecting at the ligament of Berry
- Near-total option and the specimen
Hemostasis and closure
Confirming no bleeding and closing the layers
- Checking for bleeding
- Inspecting for hemostasis
- Closing the strap muscles
- Closing the strap muscles
- Closing platysma and skin
- Closing platysma and skin
- After surgery
- Key points
- References
- Atlas of Thyroid Surgery