Objectives
Assess the anatomy, physiology, and pathophysiology of the Thyroidectomy. Analyze the diagnostic and surgical interventions for a patient undergoing a _______________. Plan the intraoperative course for a patient undergoing_____________. Assemble supplies, equipment, and instrumentation needed for the procedure.
Objectives
Choose the appropriate patient position Identify the incision used for the procedure Analyze the procedural steps for_____________. Describe the care of the specimen Discuss the postoperative considerations for a patient undergoing _______________ .
Definition/Purpose of Procedure
Total Thyroidectomy
removal of thyroid gland for malignancy or to relieve compression on the trachea or esophagus
Purpose:
Total: to treat various diseases of the thyroid; usually cancer by removal of gland (ablative) Subtotal: enlarged glands affecting breathing or swallowing problems; tracheal or esophageal obstruction
Relevant A & P
Relevant A & P
Pathophysiology
Hyperthyroidism Goiter Cancer
Pathophysiology
Pathophysiology
Diagnostics
Exams: H & P, Visual/ Palpation Preoperative Testing
TA test TSH test (sensitive assay) T4 test T3 test T3 uptake test RAI uptake test Thyroid suppression test
Anatomic perimeters
Begins w/anterior neck and extends to point of chin or cheekbones (surg pref), to nipples, to bedline
Order of draping
Crushed/wadded absorptive towels on either side of neck, head drape, and split sheet
Thyroid Sheet
Specific: Specialty Mastin muscle clamp Lahey thyroid tenaculum, Green thyroid (loop) retractor, Lahey thyroid retractor, Beckman self-retaining retractor, Ligating clip appliers Bipolar forceps w/cord
Thyroid Instruments
Incision is extended through the subcutaneous tissues & Platysma muscle divided. Superior and inferor flaps are mobilized and retractors are placed
* Prepare self-retaining retractor of choice
Strap muscles are separated w/blunt and sharp dissection Thyroid lobe is elevated & exposed with a Lahey tenaculum and the sternocleimastoid muscle is retracted with a Green retractor
Care is taken to identify the parathyroid glands and preserve the recurrent laryngeal nerve. The parathyroid glands are mobilized & vascular supply is preserved.
Above steps may require use of small right angle clamps and ligature on passer. Many steps are repeated. Keep two clamps, scissors, and ties ready
Strap muscles are approximated with an interrupted suture Penrose drain may be inserted in thyroid bed and brought to the outside Platysma is approximated Skin is closed w/staples, or nonabsorbable suture and collar-type dressing is applied
Counts
Initial: sponges and sharps (instruments) First closing Final closing
Sponges Sharps Instruments
Postoperative Care
Destination
PACU: position in Fowlers CAUTION:
STSR will maintain integrity of sterile field until pt leaves OR proper Ensure tracheotomy tray is transported postop w/pt and stays at bedside for at least 24 hrs
Postoperative Care
Potential complications
Hemorrhage from major arteries in the neck Infection Tracheal edema w/resultant obstructed airway Other: Damage to
Accidental removal of parathyroid glands with resulting tetany Damage to one or both recurrent laryngeal nerves w/paralyzed vocal cords and completely obstructed airway Thyroid storm from excessive manipulation of toxic gland.
Resources
www.allrefer.com STST pp. 461-466 Procedure 14-13 Alexanders pp. 629-631 Berry & Kohn p. 858 Fullers p. 171, 108, 322-324 MAVCC Unit 3 OBJ 12, 13, 14, 15 Complete Review of ST: Boegli. Rogers, McGiness
Patients having neck surgery are more likely to encounter respiratory problems from edema. The equipment to accompany these patients from surgery is:
a. Suction
b. Tracheotomy set c. Oxygen
d. Packing
Surgical hazards associated with a Thyroidectomy include all of the following except:
a. Damage to one or both recurrent laryngeal nerves b. Damage to the facial nerve c. Accidental removal of the parathyroid glands d. Hemorrhage from major arteries in the neck
The subcutaneous neck muscle that covers the anterior portion of the neck region from the jaw to the clavicle is called the __________________ muscle.
a. Platysma b. Deltoid c. Sternocleidomastoid
d. buccinator
The tissue that may be accidentally resected during a Thyroid Lobectomy is: a. A scalene node
b. The larynx
c. Parathyroid gland (s) d. A cervical lymph node