霍普金斯手术记录：微创甲状旁腺切除术

Title of Operation:

Minimally invasive parathyroidectomy.

Recurrent laryngeal nerve monitoring.

Indications for Surgery:福建省立医院基本外科黄东航

Parathyroid adenoma within the right carotid sheath.

Preoperative Diagnosis:

Primary hyperparathyroidism.

Postoperative Diagnosis:

Anesthesia:

Specimen (Bacteriological, Pathological or other):

Prosthetic Device/Implant:

Surgeons Narrative:

Second Assistant:  Dr. ******.

Under general anesthesia with endotracheal intubation, the patient"s neck was prepped and draped in a normal sterile fashion.  She was placed in a semi-Fowler position with neck hyperextended.  SCDs were up and working prior to anesthesia.  At first, a limited collar incision was made through skin and platysma.  Superior and inferior flaps were created in usual fashion to thyroid cartilage superiorly, sternal notch inferiorly. Careful exploration revealed only a thyroid nodule on the right mid posterior thyroid gland.  Further exploration revealed a recurrent laryngeal nerve.  It was preserved in its function and was documented with recurrent laryngeal nerve monitor and a normal parathyroid gland within the thymus. Because we had difficulty identifying the right thyroid upper parathyroid gland and because we had difficulty mobilizing the superior pole, the incision was extended to include a full Kocher incision.  This afforded us better means of exploring the right upper portion of the neck.
Finally, within the carotid sheath, we found a parathyroid adenoma in the upper portion of the carotid sheath.  This was carefully dissected, its blood supply tied off with 2-0 and 3-0 silk suture.  The baseline was 149, by the time the parathyroid was removed, it dropped to 38.  The wound was irrigated copiously with normal saline.  Bleeding vessels were either retied or recauterized.  Thrombin and Gelfoam were left in place within the wound.  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 dry sterile dressing were applied.  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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