This surgical atlas illustrates the various successful thyroid surgery techniques of world-renowned surgeons. Some approaches presented include total thyroidectomy, right thyroid lobectomy, left thyroid lobectomy, minimally invasive approach to thyroidectomy, video-assisted approach to thyroidectomy, and endoscopic approaches, such as the transaxillary approach, bilateral axillo-breast approach (BABA), and trans-oral thyroid surgery (TOEVA). The Atlas is intended for a broader audience than publications for other procedures since thyroidectomy is among the most common neck procedures. The Atlas of Thyroid Surgery will help all surgeons caring for patients with thyroid disease minimize complications and perform successful thyroidectomy.
Author(s): Alexander Shifrin
Publisher: Springer
Year: 2022
Language: English
Pages: 238
City: Cham
Preface
Acknowledgments
Contents
Contributors
1: Right Thyroid Lobectomy
Introduction
Anatomical Considerations
Recurrent (Inferior) Laryngeal Nerve (RLN)
Inferior Thyroid Artery
Tubercle of Zuckerkandl
Parathyroid Glands
Instruments Set (Fig. 1.3)
Patient’s Case
Patient’s Preparation, Intubation, and Positioning
Procedure Step by Step
Skin Mark, Muscle Incision, and Access to the Thyroid Gland (Lobe)
Lateral Mobilization of the Thyroid Lobe with Division of the Middle Thyroid Vein
Mobilization and Transection of the Superior Pole Vessels with Identification and Preservation of the External Branch of the Superior Laryngeal Nerve (EBSLN)
Identification and Preservation of the Inferior Parathyroid Gland
Identification, Dissection, and Preservation of the Right Recurrent Laryngeal Nerve
Identification, Dissection, and Preservation of the Right Superior Parathyroid Gland
Transection of Berry’s Ligament
Dissecting the Thyroid Lobe Off the Trachea with Isthmus and Pyramidal Lobe
Muscle and Skin Closure
Surgical Pearls
Management of Complications
Hematoma
Postoperative Hypocalcemia
RLN Injury
References
2: Open Right Thyroid Lobectomy
Introduction
Procedure
References
3: Thyroid Lobectomy
Procedure
Reference
4: Left Thyroid Lobectomy
Case Description
Introduction
Procedure
Positioning
Obtaining Exposure
Identification of the Recurrent Laryngeal Nerve
Identification and Inclusion of Pyramidal Lobe
Mobilization of the Superior Pole
Mobilization of the Inferior Pole
Medialization of the Thyroid
Parathyroid Assessment and Transplantation
Closure
Tips and Pitfalls
References
5: Total Thyroidectomy
Introduction
Case Description
Procedure
Suggested Reading
6: Total Thyroidectomy for Substernal Goiter
Introduction
Procedure
Suggested Reading
7: Left Thyroid Lobectomy as Completion of Total Thyroidectomy with Central Neck Lymph Node Dissection on the Left
Introduction
Instruments (See Chap. 1, Fig. 7.3)
Case
Procedure Step By Step
Patient Position, Old Scar Excision, Muscle Incision, and Access to the Thyroid Lobe
Lateral Mobilization of the Left Thyroid Lobe with Division of the Middle Thyroid Vein
Mobilization and Transection of the Superior Pole Vessels with Identification and Preservation of the External Branch of the Superior Laryngeal Nerve (EBSLN)
Identification of the Left Recurrent Laryngeal Nerve
Identification and Preservation of the Left Inferior Parathyroid Gland
Identification and Dissection of the Left Recurrent Laryngeal Nerve and the Left Superior Parathyroid Gland
Transection of Berry’s Ligament
Dissecting the Thyroid Lobe Off the Trachea
Central Neck Lymph Nodes Dissection
Irrigation, Followed by Muscle and Skin Closure
Surgical Pearls and Management of Complications
Thoracic Duct Injury
References
8: Total Thyroidectomy
Introduction
Surgical Procedure
References
9: Left Thyroid Lobectomy and Isthmusectomy
Introduction
Description: Left Thyroid Lobectomy and Isthmusectomy
Suggested Reading
10: Total Thyroidectomy and Ipsilateral Central Lymph Node Dissection for the Management of Papillary Thyroid Carcinoma
Introduction
Procedure
References
11: Hemithyroidectomy with en bloc Ipsilateral Central Node Dissection for Low-Risk Papillary and Medullary Thyroid Cancer
Introduction
Procedure
References
12: Video-Assisted Thyroidectomy
Introduction
Indications
Operative Technique
Patient and Surgical Team Positions
Anesthesia
Surgical Instruments
Surgical Technique
Conclusions
References
13: Robotic Total Thyroidectomy via Bilateral Axillo-Breast Approach (BABA)
Introduction
Procedure
References
14: Transoral Endoscopic Total Thyroidectomy via Vestibular Approach (TOETVA)
Introduction
Indication and Contraindication of TOETVA
Procedure
Position and Preparation
Incision
Flap Formation
Midline Dissection and Isthmectomy
Lateral Dissection
Upper Pole Ligation
Recurrent Laryngeal Nerve Identification and Preservation
Lower Pole Ligation and Resection of the Gland
Specimen Retrieval
Contralateral Resection
Suture and Stitch-Out
Conclusion
References
15: Transoral Endoscopic Thyroidectomy via Vestibular Approach (TOETVA)
Introduction
Procedure
Tips and Pitfalls
References
16: Safe Thyroidectomy in Low- and Middle-Income Countries
Case: A Young Patient with Advanced Thyroid Carcinoma
Low- and Middle-Income Countries
Surgical Missions
Differences in Thyroid Surgery in Low- and Middle-Income Countries Compared to High-Income Countries
Pathology
Goitre
Thyrotoxicosis and Auto-immune Disorders
Thyroid Malignancy
Infection
Diagnostics
Clinical Signs
Ultrasound
Cytology/Histology
Surgery
Follow-Up
Take-Home Messages
References
17: Total Thyroidectomy with Comprehensive Central and Lateral Neck Dissection for Differentiated Thyroid Carcinoma
Introduction
Surgical Technique
Patient’s Preparation and Positioning
Skin Incision and Flap Elevation
Selective Lateral Neck Dissection: Levels II–Vb
Unwrapping the SMC
Preparing the Submandibular Triangle
Dissecting the Medial Boundary
Dissecting Level II
Level III and IV Dissection
Completing Level Vb Dissection (Supraclavicular Triangle)
Central Neck Dissection (Levels VI–VII)
Strap Muscle Dissection
Dissection of the Lateral Boundary (Exposure of the CCA)
Identification of the ILN and Paratracheal Dissection
Pretracheal Dissection
Prelaryngeal (Delphian) Nodes
Wound Closure
Conclusion
References
18: Thyroidectomy for Substernal Goiter
Introduction
Procedure
Positioning
Incision and Exposure
Thyroid Isthmus Division
Superior Pole Ligation
Medial Dissection with “Toboggan” Technique
In Case of Sternotomy
Closure
References
Index
