Total thyroidectomy for benign multinodular goiter on both sides.

After checking for hemostasis under simultaneous PEEP ventilation, the wound is closed in layers, which in the film example consists of adapting single button sutures of the straight anterior neck muscles and a resorbable intracutaneous skin suture.

The surgical technique is demonstrated using a multinodular goiter II°. The procedure begins on the right side.

Cervicotomy (Kocher incision) in the area of the previously marked skin incision approximately 2 fingerbreadths above the jugulum.

Tip:
A skin incision placed too low can lead to keloid formation.
For large goiters, the incision should be placed higher, as it will lower after the goiter is removed.

After transecting the subcutis down to the ventral cervical fascia, the mobilization of the skin-platysma flap is performed cranially up to the larynx and caudally to the jugulum, while attempting to preserve the straight cervical veins as much as possible.

Entering the linea alba colli and splitting the straight neck muscles longitudinally, then detaching them initially from the right thyroid lobe, which is prepared first.

Tip:
To avoid bleeding from the veins, it is important to find the correct connective tissue space between the thyroid and the muscles.

After transection of the Kocher vein (Vena thyreoidea media), the carotid sheath is opened and the vagus nerve is located between the internal jugular vein and the common carotid artery. Conducting vagus neuromonitoring.

Note: The muscle response potentials are recorded via a surface electrode on the tube (alternatively also via needle electrodes). This EMG recording is made acoustically perceptible to the surgeon by a tapping signal and simultaneously a characteristic waveform is displayed on the monitor, where latency and amplitude define the intact nerve conduction.