霍普金斯手术记录：颈入路胸骨后甲状腺全切除

Title of Operation:

Total thyroidectomy for a substernal goiter through a cervical approach.

Subtotal parathyroidectomy.

Partial thymectomy.

Recurrent laryngeal nerve monitoring.福建省立医院基本外科黄东航

Indications for Surgery:

Preoperative Diagnosis:

Substernal goiter multinodular.

Primary hyperparathyroidism with four-gland hyperplasia.

Postoperative Diagnosis:

Substernal goiter multinodular.

Primary hyperparathyroidism with four-gland hyperplasia.

Anesthesia:

Specimen (Bacteriological, Pathological or other):

Prosthetic Device/Implant:

Surgeons Narrative:

First Assistant:  *** ***, MD

Operative Findings:  Significantly enlarged substernal goiter extending down towards the aortic arch and four-gland hyperplasia as well as the parathyroid within the left thymus.

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 and retracted to the right.  The right strap muscles were also divided horizontally. Anterior jugular veins were taken between clamps and tied with 2-0 and 3-0 silk sutures.  Dissection of the right goiter was done in a subcapsular fashion.  Recurrent laryngeal nerve was noted and carefully preserved. Its function was documented throughout the entire operation.  The inferior parathyroid gland was excised.  It was noted to be partially cystic.  The PTH, however, only went from 188 to 149.  Further exploration revealed a significantly large parathyroid adenoma within the tracheoesophageal groove.  This parathyroid was also excised and the PTH dropped then went down as low as 51.  As part of the research protocol, fine-needle aspiration biopsies were obtained from the large thyroid nodule on the right and sent off for research purposes only.  Blood supply to the thyroid was taken between clamps and tied with 2-0 or 3-0 silk suture or with a LigaSure.  Similar dissection occurred on the left side delivering the goiter from within the chest as well on that side. The left superior parathyroid gland was noted be significantly enlarged and bilobed. Three-quarters of this work was excised and sent to Pathology and further exploration revealed a significantly enlarged parathyroid within the thymus on the left. This was delivered after a thymectomy was performed on the left. Recurrent laryngeal nerve on the left was noted and carefully preserved.  Its function was documented throughout the entire course and during the operation.  The specimen was then sent to Pathology.  The PTH finally dropped to 26 after removal of the left superior parathyroid gland.  The wound was irrigated copiously with normal saline.  Bleeding vessels were either retied or recauterized.  Strap muscles were closed with running locking 3-0 Vicryl suture.  Platysma was closed with interrupted 3-0 Vicryl suture.  Skin was closed with a running subcuticular 4- 0 Biosyn.  Benzoin, Steri-Strips, and a dry sterile dressing were applied.  The patient tolerated the procedure very well and was sent to recovery room in stable condition.  The strap muscles were closed, also the horizontal incision was closed as well. The thrombin and Gelfoam were left within the tracheoesophageal groove bilaterally.  The patient tolerated the procedure very well and was sent to the recovery room in stable condition.  I was present for the entire case.

CLINICAL STAGE OF TUMOR:

CC List: