← All decks
General Surgery
Total Thyroidectomy for Substernal Goiter
Built from Atlas of Thyroid Surgery
What’s inside
5 sections · 48 slides
Overview
- Scope of this chapter
Indications and evaluation
Why operate, nonsurgical options, and the preoperative work-up
- Why an enlarging goiter needs surgery
- Reasons to operate
- Pemberton's sign
- Radiofrequency ablation for goiter
- Radioactive iodine for goiter
- Preoperative evaluation
- Rapid growth warning signs
- Ultrasound versus CT before surgery
- Planning for possible sternotomy
Patient presentation and imaging
A 57-year-old woman with a growing, substernal goiter
- The patient
- 8 cm
- Neck fullness on examination
- Ultrasound findings
- Ultrasound of bilateral thyroid enlargement
- CT findings
- CT of substernal goiter
Surgical technique
Positioning, exposure, delivery, and nerve protection
- Setup and positioning
- Beach chair position
- Nerve monitoring
- NIMS nerve monitoring
- Operative sequence at a glance
- The incision
- Kocher incision marking
- Raising the flaps
- Subplatysmal flaps
- Opening the midline
- Avascular midline
- Retracting the strap muscles
- Sternohyoid retracted laterally
- Dividing the sternothyroid
- Sternothyroid divided
- Freeing the upper pole
- Delivering the substernal goiter
- Interclavicular ligament division
- Protecting the recurrent laryngeal nerve
- Recurrent laryngeal nerve course
- Protecting the parathyroid glands
Specimen, closure, and recovery
Confirming the resection, closing the neck, and postoperative care
- Confirming the resection
- Specimen review
- Closing the neck
- Subcuticular closure
- When to place a drain
- Postoperative care
- Sternotomy is now rare
- Key takeaways
- References
- Atlas of Thyroid Surgery