Total Unilateral Lobectomy and Isthmusectomy

Thyroid surgery is one of the most commonly performed surgical head and neck procedures. It is important to understand the anatomy of the thyroid—and the pathology it can be associated with—when considering the surgical removal of part or all of the thyroid gland. In this chapter, we discuss the use of intraoperative nerve monitoring of the recurrent laryngeal nerve (RLN) with a monitoring endotracheal tube with electrodes at the level of the cords and the use of a nerve stimulator probe. Positioning of the patient is also described to optimise access and exposure during surgery. A step-by-step surgical approach is described, from making the incision, separating the strap muscles and dissecting the thyroid gland, with the preservation of the parathyroid glands and the RLN. Surgical technique and the use of energy instruments when dividing the vascular pedicles are also included. Once the specimen is removed, haemostasis and wound closure are important final steps for a successful outcome and reducing post-operative complications. A brief description on post-operative management and assessment concludes this chapter.