Conventional Open Thyroidectomy

Thyroidectomy is one of the most commonly performed endocrine procedures in the world. Conventional open thyroidectomy is more frequently undertaken than its minimally invasive counterpart. Elective open thyroidectomy is the treatment of choice for benign and malignant thyroid disease and includes total and near-total thyroidectomy, and lobo-isthmectomy. Open thyroidectomy requires careful preoperative patient preparation and, among other skills, thorough knowledge of the regional anatomy and its variations and mastering of the distinct steps of the surgical technique. These steps are: incision; exposure of the thyroid gland; dissection of the superior parathyroid glands; identification and preservation of the external branch of the superior laryngeal nerve; isolation and ligation of the superior thyroid artery and middle thyroid vein; identification and preservation of the recurrent laryngeal nerve (RLN) throughout its course, and of the inferior parathyroid glands before ligation of the inferior thyroid artery (ITA). High variability characterizes the relationship between the RLN and the other anatomical structures of the anterior compartment of the neck, although generally it is consistently found within a few millimeters of the ITA. Use of the harmonic scalpel or electrothermal bipolar vessel sealing system must be careful throughout the procedure so as not to cause thermal damage.