DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Thyroglossal duct cyst.
POSTOPERATIVE DIAGNOSIS: Thyroid cyst.
OPERATION PERFORMED: Excision of thyroid cyst.
SURGEON: John Doe, MD
ANESTHESIA: Oroendotracheal.
DESCRIPTION OF OPERATION: Under suitable oroendotracheal anesthesia, the patient was placed in the supine, neck-extended position. The neck was then prepped and draped in a sterile fashion. A linear incision was marked off transversely over the lower neck over the position of the palpable mass. Methylene blue tattoos were used to tattoo the skin to assist closure of the wound and alignment. The soft tissue of the neck was injected with epinephrine 1:200,000 solution to provide hemostasis with vasoconstriction as well as for hydrodissection to facilitate lifting up of the soft tissue.
An incision was made through the skin along the proposed incision line down through the skin into the fatty areolar tissue. The dissection was continued sharply through the platysma. Superficial bleeders were then controlled with silk ties and with bipolar cautery. The strap muscles were located and the soft tissue elevated off the strap muscles both superiorly and inferiorly. Following this, the fascia was entered in the midline between the strap muscles using blunt and sharp dissection. The strap muscles were elevated off the surface of the cyst. The cyst appeared to be a dark colored 2 to 2.5 cm cyst, extending from what appeared to be the isthmus of the thyroid superiorly. It was relatively thin walled and fragile appearing. Slow but methodical dissection was continued largely bluntly separating the strap muscles, which were closely adhered to the cyst from the cyst wall itself. It became evident that the cyst sat in the depression just above the isthmus of the thyroid and was very closely related to the thyroid isthmus consistent with a superficial thyroid cyst rather than a thyroglossal duct cyst.
The dissection was continued slowly, both sharply and bluntly, carefully, providing hemostasis on the surface of the thyroid gland that was exposed using the bipolar cautery. The cyst was transected at its base just as it came off of the thyroid isthmus. The stump of the inferior thyroid as well as the inferior cystic side was tied off with 3-0 silk. The dissection was then continued sweeping the cyst up superiorly until it was totally removed from the surface of the isthmus and the medial aspect of the thyroid lobes. Superiorly, there did not appear to be any tract going up toward the hyoid again confirming that this is probably a thyroid cyst rather than a thyroglossal duct cyst. The cyst was successfully removed intact and sent for pathology.
The wound was then carefully checked for any bleeders and these were controlled with ties of 4-0 silk as well as with bipolar cautery. The wound was irrigated and rechecked. When hemostasis was achieved, a 1/4-inch Penrose drain was placed into the wound. The deep portion had been split so that one limb of the drain went deep and was to sit below the level of the strap muscles. The strap muscles were then approximated in the midline with interrupted sutures of 4-0 Vicryl. The second limb of the drain was placed in the subcutaneous space. The subcutaneous tissue was approximated with interrupted sutures of 4-0 Vicryl. The skin was closed with a running subcuticular 5-0 Monocryl. The drain was left to drain through the midline. It had been secured to the skin with a 4-0 Vicryl stitch. The incision line was then reinforced with Steri-Strips after tincture of benzoin had been applied to the skin. A fluffy dressing was placed over the neck and the procedure was terminated. The patient tolerated the procedure well. Estimated blood loss was less than 10 mL.
