Operative Note |
PROCEDURE: Thyroidectomy. |
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SUMMARY: The patient was brought to the operating
room and prepped and draped in the usual sterile fashion. A low collar incision was made in the standard fashion and was carried
down through the platysma muscles. The strap muscles were divided in the midline until the thyroid was identified. Next
dissection first proceeded with dissection of the left lobe of the thyroid. This was done from inferior pole to superior pole
fashion using blunt dissection and hemoclip to protect the inferior thyroid arteries, thyroid glands, thyroid arteries and all branching
structures in this region with care taken to hug the capsule at all times. The thyroid was then reflected up until it
was attached to the trachea and ligament of Berry was identified at this point. A Ray-Tec was placed behind the thyroid and
attention was turned to the right lobe of the thyroid. Upon further dissection, nodule was easily identified in the right lobe
of the thyroid medially. Dissection continued the same way as the left lobe proceeding from inferior to superior pole fashion
using blunt dissection and hemoclip. Once taken, the vascular structure of the right thyroid lobe was reflected up into the
field. Dissection continued medially until reaching the trachea and taking ligament of Berry. At no time were the laryngeal
nerves visualized as the capsule was hugged at all times. Once the right lobe of the thyroid was freed, it was passed from the
field as specimen number 1. Surgicel was placed in the wound and attention was returned to the left lobe of the thyroid. The left lobe was dissected free from the trachea and ligament of Berry was divided using careful dissection without identifying the
recurrent laryngeal nerve as the capsule of the thyroid was once again hugged on this side as well. After this was done, the
left lobe was passed off as specimen number 2. Surgicel was placed in the wound as well. After approximately 5 minutes
of observation the wounds were checked and revealed no clotting in either wound bed. Surgicel was left in place and the strap
muscles were reapproximated loosely with interrupted Vicryl sutures. The platysma was reapproximated as well with several interrupted
Vicryl and the skin was reapproximated with running subcuticular Vicryl. 10 cc of 0.25% Marcaine were used for postoperative
analgesia. Sterile dressing was applied to the wound. At this point and time, the patient was awakened, extubated, and
taken to post-anesthesia care unit in stable condition. Lap and needle counts were correct X 2 as reported to me.
Of
note, the patient was checked in post-anesthesia care unit postoperatively and found to have adequate vocal function and was able
to annunciate vowels appropriately.
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