General Surgery

Hemithyroidectomy

OPERATION: Hemithyroidectomy (Right / Left)
ANAESTHETIC: General endotracheal anaesthesia
POSITION: Supine with neck extended over shoulder roll

INDICATION:
[Solitary thyroid nodule with follicular cytology / dominant cold nodule in multinodular goitre / suspicious cytology]. Preoperative investigations: USS [findings], cytology [result]. Laryngoscopy confirming normal bilateral vocal cord movement.

PROCEDURE:
WHO Checklist performed. Transverse skin crease incision 2–3 cm above sternal notch. Platysma divided in line with incision. Superior and inferior skin flaps elevated. Self-retaining retractor positioned.

Deep cervical fascia incised in midline. Strap muscles retracted laterally — division of strap muscles not required.

Thyroid lobe mobilised by dividing middle thyroid veins and inferior thyroid veins, ligated individually. Superior pole vessels ligated close to the gland to protect the external laryngeal nerve — external laryngeal nerve identified / protected. Inferior thyroid artery ligated lateral to recurrent laryngeal nerve insertion after nerve identification and confirmation of position.

Recurrent laryngeal nerve identified throughout its course to larynx. Parathyroid glands identified and preserved with their vascular supply.

Lobe rotated medially. Deep surface of lobe dissected off trachea. Isthmus divided close to contralateral lobe and oversewn with continuous absorbable haemostatic suture.

Haemostasis confirmed. [Frozen section sent / not required].

Suction drain placed deep to strap muscles. Strap muscles approximated. Platysma sutured with absorbable suture. Skin closed with subcuticular suture.

FINDINGS:
[Right / left] thyroid lobe [describe macroscopic appearance, consistency, nodule characteristics]. Parathyroid glands [number identified, location].

SPECIMEN: Thyroid lobe to histopathology.
EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Regular analgesia. Drain removed when output minimal. Calcium monitoring [if parathyroid glands at risk]. Results and further management discussed at follow-up.