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Thyroid Cyst Removal with Hemithyroidectomy

This video shows a thyroid cyst removal that resulted in a hemithyroidectomy. The patient is placed under general anesthesia and intubated using a mac video laryngoscope and an EMG endotracheal tube. The ET tube has 4 stainless steel wire electrodes which touch the vocal cords for monitoring during surgery. After video intubation electrode placement is verified by direct stimulation of the area.

The surgeon makes a curvilinear skin crease incision in the front of the neck, to minimize the visibility of a scar. Afterwards, subplatysmal flaps are elevated and the midline raphe is dissected exposing the sternohyoid muscle, which is retracted laterally, and the sternothyroid muscle that is dissected off the left thyroid gland.

The thyroid cyst is found superficial and dissected, keeping in mind that anything suspicious for the recurrent laryngeal nerve is stimulated prior to dissection. The cyst is ruptured and sent for frozen pathology. The results returned as thyroid, so the surgeon proceeded with a hemithyroidectomy. The superior and inferior parathyroids were identified and dissected free. Hemostasis was achieved with electrocautery and confirmed with Valsalva. Strap musculature platysma and skin are closed. And lastly, mastisol and steri-strips are placed perpendicular to the wound.

Thyroid Cyst Removal with Hemithyroidectomy
A thyroid cyst removal is a surgical procedure typically performed for various indications, such as: size of the nodule, malignancy, unilateral thyroiditis, or cosmetic concerns. This procedure can result in a complete or hemithyroidectomy.
Contraindications for this procedure includes malignancy in both lobes, severe thyroid disease and coagulation disorders.
The patient is placed under general anesthesia and intubated using a mac video laryngoscope and an EMG endotracheal tube. The ET tube has 4 stainless steel wire electrodes which touch the vocal cords for monitoring during surgery.
Diagnosis is made by physical examination, lab work and imaging. An ultrasound can be used to identify nodules or cysts present on the gland. MRI or CT can also be used to identify other lesions and evaluate the extent of the mass.
The platysma and strap muscles have to be dissected to gain access to the gland. It’s important to preserve the function of the RLNs (recurrent laryngeal nerves) and other nerves that play a crucial role in vocal cord movement, swallowing and sensation of the neck and throat.
Advantages: helps preserve the function of the gland by removing only one lobe Disadvantages: Risk of damaging parathyroid glands or the laryngeal nerves.
Complications such as infections and risk for contralateral disease. Risks include damage to nerves that play a role in vocal cord movement, swallowing and sensation of neck and throat, hypocalcemia, among others.
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CUHK Department of Otorhinolaryngology, Head and Neck Surgery. (n.d.). Thyroidectomy. In Head and Neck Dissection and Reconstruction Manual (pp. 6). Retrieved from https://www.ent.cuhk.edu.hk/images/publication/head-and-neck-dissection-and- reconstruction-manual/06_THYROIDECTOMY.pdf

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