DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Papillary thyroid carcinoma.
POSTOPERATIVE DIAGNOSIS:
Papillary thyroid carcinoma.
OPERATION PERFORMED:
1. Total thyroidectomy.
2. Continuous right recurrent laryngeal nerve monitoring, one hour.
3. Continuous left recurrent laryngeal nerve monitoring, one hour.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General, 8 mL of 0.5% Marcaine with epinephrine.
INDICATIONS FOR OPERATION: This (XX)-year-old gentleman was found to have bilateral papillary carcinoma on ultrasound followed by ultrasound-guided thyroid biopsies.
DESCRIPTION OF OPERATION: The patient was intubated with Xomed nerve monitor endotracheal tube, and the neck was extended with the shoulder roll. A transverse cervical incision was made. The incision was made approximately two fingerbreadths above the sternal notch. The incision was deepened beyond the platysma.
Superior flap was developed to the thyroid notch and anterior flap to the sternal notch. Crossing anterior jugular veins were ligated with 2-0 silk ties and divided. The left strap muscles were lifted off the left thyroid gland, and the middle thyroid vein was ligated with 4-0 silk ties and divided. The recurrent laryngeal nerve was identified at the base of the neck and traced anteriorly.
The inferior thyroid vascular bundle was identified anterior to the nerve, doubly ligated with 2-0 silk ties and divided. The left lower parathyroid gland was found anterior to the nerve and left intact. The superior thyroid vascular bundle was then identified, doubly ligated with 2-0 silk ties and divided. We were able to identify the upper parathyroid gland. It was in fact intrathyroidal. We separated this from the thyroid gland, and it was noted to be viable.
The nerve was transverse as it entered the larynx, and we subsequently separated the thyroid gland from the nerve. At the isthmus, the gland was divided, and the stump was ligated with 2-0 silk ties. The specimen was then removed after it was lifted off the trachea. Frozen section showed a papillary carcinoma. The left recurrent laryngeal nerve was noted to be functioning at the end of this dissection.
The right strap muscles were then taken off the right thyroid gland. Middle thyroid vein was ligated with 4-0 silk ties and divided. A right recurrent laryngeal nerve was found at the base of the neck and traced as it entered the larynx. The inferior thyroid vascular bundle was doubly ligated with 2-0 silk ties and divided. The inferior parathyroid gland was identified and found to be viable, and it was also found anterior to the recurrent laryngeal nerve.
The right thyroid superior artery was doubly ligated with 2-0 silk ties and divided. This allowed us to further mobilize the right thyroid gland. The right upper parathyroid gland was found posterior to the nerve. This was left intact. The thyroid gland was then lifted off the nerve and separated, and we then removed the specimen off the trachea. The right recurrent laryngeal nerve was noted to be functional throughout the dissection.
Hemostasis was then achieved with 4-0 silk ties. Both nerves were then reinspected prior to closure. They were both noted to be functional. Strap muscles were approximated with running 4-0 Vicryl at the midline and interrupted 4-0 Vicryl were used for the platysma closure. A 5-0 Monocryl was used for subcuticular skin closure.
The patient tolerated the procedure well. Sponge and needle counts were correct. Blood loss was minimal. The patient was extubated and taken to the recovery room in stable condition.
