Excision of solitary parathyroid adenoma

Anatomy Perioperative management Technique Complications Evidence Total Video

Skin incision

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Incise the skin 2 finger widths (2-3 cm) superior to the suprasternal notch between the bellies of the left and right sternocleidomastoid muscles (so-called Kocher or collar incision). Divide the platysma with electrocautery.
Note: In single parathyroid adenomas with well-known location the skin incision may be much smaller than, e.g., in thyroidectomy.
Subcutaneous dissection, midline division

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Divide the subcutaneous tissue and enter the white line of the neck. Between forceps divide and ligate any superficial jugular veins in the cervical fascia.
Tip: Simple ligatures of the cervical veins often slip off during surgery. Closure is best accomplished by suture-ligation (PDS 3/0).
Exposing the thyroid

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Retract the strap muscles of the neck from the anterior aspect of the thyroid. Expose both thyroid lobes circumferentially, expose the trachea and divide any superficial vessels encountered.