Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique |
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Authors: | Richard D Bliss Paul G Gauger Leigh W Delbridge |
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Institution: | (1) Department of Surgery, Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales 2065, Australia, AU |
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Abstract: | The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology.
With appropriate techniques, total thyroid lobectomy and total thyroidectomy (which should be considered simply as a bilateral
total thyroid lobectomy performed during the same operation) can be undertaken with minimal risk of damage to the recurrent
laryngeal nerves, the external branches of the superior laryngeal nerves, and the parathyroid glands. Safe surgery requires
a specific operative plan, progressing in a series of logical, orderly, anatomically based steps. Exposure of the thyroid
gland is followed by careful dissection of the superior pole, utilizing the avascular plane between the superior pole and
the cricothyroid muscle to identify and preserve the external branch of the superior laryngeal nerve. Medial retraction of
the gland then allows dissection of the lateral aspect of the thyroid lobe. Protection of the recurrent laryngeal nerves and
preservation of the blood supply to the parathyroid glands is best achieved by “capsular dissection,” ligating the tertiary
branches of the inferior thyroid artery on the gland surface. If a parathyroid gland cannot be preserved or becomes ischemic
after dissection of its vascular pedicle, it should be immediately minced and autotransplanted into the ipsilateral sternocleidomastoid
muscle. The current evolution of outpatient or short-stay thyroidectomy emphasizes the need to avoid complications by utilizing
meticulous surgical technique. Minimally invasive thyroidectomy utilizing endoscopic techniques may also affect the practice
of thyroid surgery. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount
to safe and effective surgery. |
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