DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Primary hyperparathyroidism.
POSTOPERATIVE DIAGNOSIS: Primary hyperparathyroidism.
OPERATION PERFORMED: Parathyroidectomy and left thyroid lobectomy.
SURGEON: John Doe, MD
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed in the supine position on the operating room stable. Satisfactory general endotracheal anesthesia was induced using the tube for recurrent nerve monitoring. The head was hyperextended. The neck was prepped and draped in the usual sterile fashion.
A standard incision was then made utilizing the left side of the neck for standard collar incision. This was carried down through the skin and subcutaneus tissues. There were veins encountered along the strap muscles that required ligation with stick ties of 3-0 Vicryl and ties of 2-0 silk. The strap muscle was retracted at the midline and the area explored. Despite preoperative localization with nuclear medicine scan, it was very difficult to identify parathyroid through this area. Accordingly, the incision was extended and converted to standard collar incision. Strap muscles were further divided, and the area was then able to be explored. We did identify a parathyroid in the left lower pole. This was sent for analysis. Parathyroid hormone level was redrawn, and the remainder of the areas around the gland was explored.
As we explored these areas, we saw no evidence of any other adenoma. The exploration continued down to the innominate vein at the thoracic inlet, and both upper poles and right lower pole were skeletonized. There appeared to be what might have been a small parathyroid attached to the right lower pole. This appeared to be mostly fatty tissue, but there was a small amount of reddish tissue associated with it. We left this in place while we continued our dissection and awaited our frozen section. Surprisingly, the parathormone assay returned with a level higher than the preop, and therefore, we felt that we needed to re-explore the area. This was done, and during the course of this, we felt that it would be prudent to remove the left lobe of the thyroid.
Prior to this, there was a cystic structure in the lower pole of the gland. We removed this and sent it for frozen. This came back as a simple thyroid cyst. We then completed the lobectomy, identifying the recurrent laryngeal nerve along its course and identifying it on the right side as well during the course of our dissection. The left lobe was then sent for frozen section, which was indeterminate at the time of this dictation.
We felt at that point that no additional dissection should be continued, and we simply placed the Hemovac drain and closed the strap muscles with 3-0 Vicryl and the platysma. The skin was closed with 4-0 PDS as a subcuticular suture. Benzoin, Steri-Strips, and sterile dressings were applied. The patient tolerated the procedure well and returned to the recovery area where stat. calcium was ordered.
