Total Thyroidectomy with Central/Lateral Neck Dissection

Procedure Snapshot

• Indication: Papillary or medullary thyroid carcinoma with nodal metastases.
• Expected duration: ___
• Special instruments: Nerve monitor, bipolar sealer, retractors.

Step Workflow

1. Transverse cervical incision; elevate flaps.
2. Identify strap muscles; divide midline.
3. Identify & preserve RLN and parathyroids.
4. Ligate superior/inferior thyroid vessels close to capsule.
5. Remove thyroid en bloc.
6. Central (VI) dissection: nodes between carotid sheaths & trachea.
7. Lateral (V–III) dissection if indicated.

Key Pimp Questions

• Q: Most common nerve injury? RLN → hoarseness.
• Q: Hypocalcemia prevention? Identify/preserve parathyroids (PMID 31051264).

Critical Anatomy

• Landmarks: RLN, carotid sheath, trachea, jugular vein.
• Danger zones: Thoracic duct (left), RLN, parathyroids.

Informed Consent Highlights

• Hoarseness __ Hypocalcemia __ Bleeding __ Chyle leak __

Post-op Considerations

• Drain overnight; monitor Ca × 48 h; Ca/Vit D supplement PRN.

References

• Chassin’s, Endocrine section. Clinical Scenarios, Thyroid chapter.
• Bergenfelz 2019 (PMID 31051264).