Mayo stand and back table instruments for Parathyroidectomy surgery setup

Clamping & Occluding

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  Allis Forceps

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  Hemostatic Clip Applier

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  Kelly Forceps

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  Mosquito Clamp – Curved

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  Rienhoff Swan-Neck Clamp

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  Right Angle Clamp

Cutting & Dissecting

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  #3 Knife Handle

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  Metzenbaum Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Adson Forceps

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  Debakey Forceps

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  Smooth Adson

Retracting & Exposing

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  Freer Skin Hook

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  Lahey Thyroid Retractor

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  Mahorner Thyroid Retractor

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  Richardson Retractor

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  Weitlaner Retractor

Suctioning

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  Ferg-Frazier Suction

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  Yankauer Suction

Suturing & Stapling

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  Mayo-Hegar Needle Holder

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  Ryder Needle Holder

What to expect during Parathyroidectomy

A Parathyroidectomy is a surgical procedure performed to remove one or more of the parathyroid glands, which are responsible for regulating the calcium levels in the body. This procedure is typically done to treat hyperparathyroidism, a condition where the parathyroid glands produce too much parathyroid hormone, resulting in elevated calcium levels in the blood. The surgery involves making an incision in the neck and dissecting the gland, while ensuring the surrounding structures such as the thyroid gland, nerves, and blood vessels are not damaged.

Position
supine with neck extended

Equipment
nerve monitor probe (surgeon’s preference) I like to keep mine in my bovie holster since they are thin and somewhat sharp

Step 1: Making the Incision
The first step in the Parathyroidectomy procedure is making an incision along the collar in the neck crease using a 15 blade. The surgical technologist must hand the blade to the surgeon while maintaining a sterile field. After making the incision, the surgeon will use small retractors like skin hooks or Richardsons to dissect down to the thyroid.

Step 2: Tying Off Vessels
As the surgeon continues to dissect down to the thyroid, they may come across vessels that require tying off. Surgical technologists must ensure that silk ties are readily available to the surgeon to tie off any vessels that require ligation. It’s crucial to have a variety of different-sized clip appliers available in case the surgeon decides to use them.

Step 3: Obtaining a Baseline Sample
After the thyroid is exposed, the surgical team will take a sample of PTH serum to establish a baseline. The surgical technologist must ensure that the necessary instruments for this procedure, such as a PTH kit and a sterile syringe, are readily available.

Step 4: Dissecting the Gland
The surgeon will continue to dissect the rest of the gland from the thyroid, and another PTH sample will be taken and sent STAT to the lab. During this step, the surgical technologist must ensure that the surgeon has access to the necessary instruments, such as dissectors and scissors.

Step 5: Closing the Incision
Once the gland has been completely dissected, the surgeon will check the PTH levels to ensure they are within an acceptable range. If the levels are good, the incision will be irrigated and closed. The surgical technologist must hand the necessary instruments to the surgeon while maintaining a sterile field.

The Surgery Sparknotes

1. Make an incision along the collar in the neck crease using a 15 blade.
2. Ensure silk ties are available to tie off vessels.
3. Obtain a baseline PTH sample.
4. Dissect the gland using dissectors and scissors.
5. Check PTH levels and irrigate and close the incision.