霍普金斯手术记录：甲状腺全切+中央区淋巴结清扫+喉返神经监测

Johns Hopkins Hospital

Operative Report

Name:	*** ***.	History:	*-***-**-**
Address:	64** **** Lane福建省立医院基本外科黄东航 **** VA ***10	Date of Operation:	**/19/20**
Phone:	(***)***-****	Service:	SOE
DOB:	11/**/19**
Race:	African American
Gender:	Female
Attending Surgeon:	***,*** *
Assistant(s):	***, ***	Document No:	********

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Title of Operation:

Total thyroidectomy with selective cervical lymphadenectomy level VI.

Recurrent laryngeal nerve monitoring.

Indications for Surgery:

Preoperative Diagnosis:

Medullary thyroid cancer.

Postoperative Diagnosis:

Anesthesia:

Specimen (Bacteriological, Pathological or other):

Prosthetic Device/Implant:

Surgeons Narrative:

Findings:  Dominant tumor in the right lobe of her thyroid, 2 cm in size. Some suspicious lymphadenopathy in the bilateral central neck.

Operative Procedure:  Under general anesthesia with endotracheal intubation, the patient"s neck was prepped and draped in normal sterile fashion.  She was placed in a semi-Fowler position with the neck hyperextended.  SCDs were up and working prior to anesthesia.  A standard collar incision was made through skin and platysma.  Superior and inferior flaps were created in usual fashion to thyroid cartilage superiorly and sternal notch inferiorly.  Strap muscles were divided longitudinally in the midline, retracted to the right.  Blunt and sharp dissection revealed a middle superior and inferior thyroid vessels.  These were taken between clamps and tied with 2-0 and 3-0 silk suture or with a LigaSure. Recurrent laryngeal nerve was noted and carefully preserved throughout the dissection.  Its function was documented with recurrent laryngeal nerve monitor.  Both parathyroid glands were at the superior pole of the thyroid gland and were left in place.  There was some suspicious cervical lymphadenopathy posterior to the nerve on the right.  All the lymphatic tissue within the central neck was carefully dissected out including the thymus.  Similar dissection occurred on the left side.  Left recurrent laryngeal nerve was noted and carefully preserved.  Its function was documented with recurrent laryngeal nerve monitor throughout the case. Again both parathyroids were in a usual location, both were at the superior pole and left in situ.  Lymph nodes medial to the recurrent laryngeal nerve and inferior to the thyroid gland were dissected out along with thymus.  Specimen was sent to pathology.  The wound was irrigated copiously with normal saline.  Bleeding vessels were either retied or re-cauterized.  Strap muscles were closed with running locking 3-0 Vicryl suture.  Platysma was closed with interrupted 3-0 Vicryl suture.  Skin was closed with running subcuticular 4-0 Biosyn.  Benzoin, Steri-Strips, and a dry sterile dressing were applied.  Gelfoam and thrombin were left in place in the tracheoesophageal groove.  The patient tolerated the procedure very well and sent to the recovery in stable condition.  I was present for the entire case.

CLINICAL STAGE OF TUMOR:

CC List:

Referring Physician CC List:

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