SUBTOTAL THYROIDECTOMY - the risk of bleeding; however,...

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SUBTOTAL THYROIDECTOMY Bilateral subtotal or near total lobectomy is the usual operation for Graves’ disease. An alternative operation, which is equally good, is lobectomy on one side and subtotal or near total lobectomy on the other side (Dunhill procedure). Once more, the parathyroid glands and recurrent nerves should be identified and preserved. Great care should be taken to not damage the recurrent laryngeal nerve when cutting across or suturing the thyroid lobe. At the end of the operation, 1 or 2 grams or less of thyroid tissue is usually left in place. The aim is to try to achieve an euthyroid state without a high recurrence of hyperthyroidism. When the operation is done for severe ophthalmopathy, however, near-total or total thyroidectomy is performed. After thyroidectomy, even if a modified neck dissection is done for carcinoma, the patient can almost always be safely discharged on the first postoperative day. Others are kept longer if the need arises. I do not think that it is safe to discharge a patient on the day of surgery because of
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Unformatted text preview: the risk of bleeding; however, same-day discharge is being practiced at some centers. 52 ALTERNATIVE TECHNIQUE OF THYROIDECTOMY An alternative technique of thyroidectomy is practiced by some excellent surgeons 6,53 and is used by the author in some operations. In this technique, the dissection is begun on the thyroid lobe and the parathyroids are moved laterally as described previously. However, the recurrent laryngeal nerve is not dissected along its length, but rather small bites of tissue are carefully divided along the thyroid capsule until the nerve is encountered near the ligament of Berry. Proponents of this technique feel that visualization of the recurrent laryngeal nerve by its early dissection may lead to greater nerve damage; however, the author feels that seeing the nerve and knowing its pathway is safer and facilitates the dissection, in many instances....
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This note was uploaded on 11/22/2011 for the course BSC BSC1085 taught by Professor Sharonsimpson during the Fall '10 term at Broward College.

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