Total thyroidectomy in bilateral nodular goiter - general and visceral surgery
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Skin incision
The surgical technique will be demonstrated in stage II multinodular goiter. The procedure is started on the right side.
Kocher collar incision about 2 fingers wide superior to the suprasternal notch.Tip:
If the incision is placed too far inferior this may result in keloid formation.
In large goiters the incision should be placed somewhat more superior since it will descend once the goiter has been removed.Mobilizing the wound edges
Mobilizing the strap muscles
Incise along the white line (linea alba colli) and mobilize the strap muscles.
Tip:
It is important to identify the correct plane of connective tissue between the thyroid and the muscles because this will avoid venous bleeding. This maneuver may be rather difficult in a status post previous inflammation.
In large goiters it is recommended to transversely transect the infrahyoid muscles.
Exposing and neuromonitoring the vagus nerve
Exposing and transecting the vessels of the superior pole
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Mobilizing the inferior parathyroids and exposing the recurrent laryngeal nerve
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Mobilizing the inferior pole
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Exposing the superior parathyroid and following the recurrent laryngeal nerve to the larynx
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Mobilizing the thyroid lobe mediad
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Removing the entire thyroid
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Wound closure
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