The indication for this procedure is enlarged thyroid causing airway obstruction and difficulty with swallowing.

   After being placed in the supine position the patient was prepped and draped in sterile fashion. A lower collar incision was made approximately one fingerbreadth above the clavicles and this was brought through the skin and subcutaneous tissue. The platysma muscle was divided and superior and inferior flaps were developed. The right thyroid was excised first due to it's smaller size. This was done by dissecting off the strap muscles and the sternocleidomastoid and reflecting the gland inferiorly first, dissecting, clamping and then reflecting the superior pole free. As this was accomplished, the gland was rotated medially and the middle thyroid vein was divided between clamps and ties and then and further rotated medially. The superior and inferior parathyroid glands were identified and left intact. The recurrent laryngeal nerve and and the inferior thyroid artery were both preserved. Branches to the thyroid gland were then ligated and cut and the gland was dissected off the trachea to the isthmus using Bovie electrocautery.
    Attention was now turned to the left thyroid gland. The strap muscles were again dissected off of the gland and reflected laterally. Dissection of the superior pole proceeded in the same fashion as above. After this the gland was again rotated from lateral to medial dividing the middle thyroid vessels. The superior and inferior parathyroid glands were again identified and preserved. The recurrent laryngeal nerve was identified and preserved.
   After achieving hemostasis, the strap muscle were re-approximated and the platysma fascia and skin closed using 3-0 vicryl and 4-0 nylon respectively.

Pathology Report