Restthyroidectomy with partial central lymph node dissection on the left

The operation demonstrates a completion surgery following a right hemithyroidectomy performed years ago due to papillary thyroid carcinoma. The current findings revealed a left uninodular goiter with an approximately 7 mm centrally located nodule and perithyroidal lymph node enlargement on the left.

Excision of the old scar from a previous Kocher's collar incision.

Mobilization of a skin-platysma flap cranially up to the larynx and caudally to the jugulum, with care to preserve the straight cervical veins as much as possible.

Fig. right (1) Sternocleidomastoid muscle, (2) Sternothyroid muscle, (3) Sternohyoid muscle

Since a right hemithyroidectomy had already been performed, the straight neck muscles are not split longitudinally in the midline as usual, but atypically, the entry into the thyroid bed is made immediately at the anterior edge of the left sternocleidomastoid muscle. For better visualization of the thyroid bed in this procedure, the omohyoid muscle is transected. During the course of the preparation, the surgeon switches sides to the left.

Identification of the vagus nerve between the internal jugular vein and the common carotid artery. Mobilization of the nerve and neuromonitoring is performed.