Total Parathyroidectomy with Autotransplantation

Typical skin incision two fingerbreadths above the suprasternal notch between the bellies of the sternocleidomastoid muscle. Division of subcutaneous tissue and platysma up to the anterior cervical fascia with a sealing instrument. Exposure of the avascular layer between platysma and anterior cervical fascia and mobilization of the skin-platysma flap cranially and caudally.

Longitudinal splitting of fascia and straight neck musculature in the midline while sparing the superficial neck veins. Then retracting the straight neck musculature from the anterior thyroid capsule.

Approach to the right thyroid side. Right-sided preparation with successive development of the upper pole. Identification and thyroid-adjacent transection of the upper pole vessels after placement of a central clip with the sealing device.

Careful medialization of the right thyroid lobe with division of the middle thyroid vein (Kocher vein). Locating and looping of the vagus nerve. A normal signal is shown with the neuromonitoring system.

Locating the recurrent laryngeal nerve and identifying it with neuromonitoring. Subsequently exposing the right upper parathyroid gland at its typical location dorsal to the recurrent laryngeal nerve. Excision of the parathyroid gland after placing clips and cauterizing smaller vessels.