HEMITHYROIDECTOMY - Operative Surgery steps.

  1. INCISION: Transverse skin crease incision is made 2-3 cm above the sternum. (Lower than this causes Scar hypertrophy)
  2. Subplatysmal flap: platysma incised in line with Skin,  Skin Platysmal flap raised. Inferior limit - sternum, superiorly  up to Thyroid cartilage.
  3. Joll's self retaining retractor to retract flaps.
  4. Deep cervical fascia incised vertically in midline.
  5. Strap muscle retracted laterally.
  6. Horizontal division of strap muscles is NOT necessory. But if done, it should be Highup (because innervations are below)
  7. Areolar tissue around gland is divided. 
  8. Middle, Inferior thyroid veins displayed, ligated, divided.
  9. Right angled forceps behind superior pole vessels. 
  10. Superior pole vessels ligated as Low as possible & a second ligature is tied above it. Vessels divided b/w ligature [Too high a tie can endanger ELN]
  11. Thyroid lobe retracted medially and carotid sheath Laterally this displays inferior Thyroid artery & RLN beneath fascial layer. which is then incised.
  12. Inferior thyroid artery ligated as lateral as possible. 
  13. Dissection of deep portion of gland off RLN and parathyroid done
  14. Medial surface of the lobe is seperated from trachea. 
  15. Isthmus is divided close to contralateral lobe.
  16. For Hemostasis, continuous absrobable suturing in isthumus is done   (OR) Harmonic Scalpel is used to divide isthumus.
  17. Vaccum Drains is placed beneath strap muscle  
  18. Platysma is sutured & skin closed using suture/staples.
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