General Surgery

Total Thyroidectomy

OPERATION: Total Thyroidectomy
ANAESTHETIC: General endotracheal anaesthesia
POSITION: Supine with neck extended over shoulder roll

INDICATION:
[Thyroid cancer / multinodular goitre / thyrotoxicosis]. Preoperative investigations: USS, cytology [results]. Bilateral vocal cord movement confirmed on laryngoscopy.

PROCEDURE:
WHO Checklist performed. Transverse skin crease incision 2–3 cm above sternal notch. Platysma divided. Skin flaps elevated. Self-retaining retractor.

Deep cervical fascia divided in midline. Strap muscles retracted laterally.

RIGHT LOBE: Superior pole vessels individually ligated close to the gland, protecting the external laryngeal nerve. Middle and inferior thyroid veins divided and ligated. Recurrent laryngeal nerve traced from inferior to superior throughout its course. Inferior thyroid artery ligated after nerve identification. Superior parathyroid gland identified and preserved. Inferior parathyroid gland identified and preserved with its vascular pedicle. Lobe dissected off trachea and removed with isthmus.

LEFT LOBE: Identical procedure performed. Both recurrent laryngeal nerves confirmed intact.

Parathyroid vascular supply confirmed [total of [number] parathyroid glands identified]. [One or more glands autotransplanted into sternomastoid if vascularity compromised].

Haemostasis confirmed. Suction drain placed. Strap muscles approximated. Platysma closed. Skin subcuticular suture.

FINDINGS:
[Describe bilateral lobes, any nodules, involvement of structures].

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

POST-OPERATIVE INSTRUCTIONS:
Thyroxine replacement commenced. Calcium and PTH levels monitored postoperatively. Drain removed when minimal output. Voice assessment postoperatively. Outpatient review with histology.