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Thyroidectomy mayo stand and back table surgery setup

Eric Bradshaw Avatar

setup author

Surgery setup images for Thyroidectomy

Thyroidectomy surgery instruments

Clamping & Occluding instruments

Rienhoff Swan-Neck Clamp
Rienhoff Swan-Neck Clamp
Right Angle Clamp
Right Angle Clamp
Kelly Forceps
Kelly Forceps
Mosquito Clamp - Curved
Mosquito Clamp – Curved
Allis Forceps
Allis Forceps

Cutting & Dissecting instruments

#3 Knife Handle
#3 Knife Handle
Potts Tenotomy Scissor
Potts Tenotomy Scissor
Straight Mayo Scissor
Straight Mayo Scissor

Grasping & Holding instruments

Debakey Forcep
Debakey Forcep
Smooth Adson
Smooth Adson
Adson Forceps
Adson Forceps

Retracting & Exposing instruments

Freer Skin Hook
Freer Skin Hook
Weitlaner Retractor
Weitlaner Retractor
Senn Retractor
Senn Retractor
Richardson Retractor
Richardson Retractor
Mahorner Thyroid Retractor
Mahorner Thyroid Retractor

Suctioning instruments

Yankauer Suction
Yankauer Suction
Ferg-Frazier Suction
Ferg-Frazier Suction

Suturing & Stapling instruments

Ryder Needle Holder
Ryder Needle Holder
Mayo-Hegar Needle Holder
Mayo-Hegar Needle Holder

What to expect during Thyroidectomy

A thyroidectomy is a surgical procedure that involves removing all or part of the thyroid gland. The thyroid gland is located in the neck and produces hormones that regulate metabolism. The surgery is usually performed to treat thyroid cancer, thyroid nodules, or an overactive thyroid gland. It is also performed to remove a goiter, which is an enlargement of the thyroid gland that can cause breathing or swallowing difficulties.

Step 1: Initial Incision and Dissection
The first step in a thyroidectomy involves making an incision across the neck with a 15 blade. The surgeon will then use cautery to dissect through the platysma muscle. Skin hooks will be used to retract the skin while the surgeon continues to use cautery to reach deeper tissue. Once the deeper tissue is reached, a self-retaining retractor will be placed to hold the incision open.

Step 2: Fascia Dissection
Next, the surgeon will use a pair of Metz to perform blunt dissection through the fascia. Some doctors prefer to use the Harmonic scalpel for this part of the surgery. The strap muscles will be divided with the Harmonic scalpel, revealing the thyroid gland.

Step 3: Further Dissection and Retraction
The surgeon will spend some time dissecting further, and may use different retractors, such as small Richardsons, to help expose the surgical site. Clips and ties may be used to divide any structures in the way.

Step 4: Laryngeal Nerve Protection
Once the laryngeal nerve has been found, it will be carefully protected. This nerve is responsible for controlling the vocal cords, and damage to it can cause significant problems. After the nerve has been protected, the thyroid can be removed. The Harmonic scalpel is usually used for this step.

Step 5: Thrombin Mesh Placement and Closure
After the thyroid has been removed, a piece of thrombin mesh might be placed in the cavity to prevent bleeding. Closure of the incision will occur in layers, and the skin may take a while to close since the surgeon will be trying to avoid thick scarring.

Tips and tricks
Peanuts/kitners should always be available loaded on Kellys in case of bleeding. The thyroid specimen should be passed off immediately. Most surgeons use nerve monitoring during thyroid surgeries, so that will be one more cord you will need to throw off (they are pretty sharp, so be careful not to puncture through the drape).

The Surgery Sparknotes

  1. Make an incision with a 15 blade and use cautery to reach the platysma.
  2. Retract with skin hooks and use cautery more. Place a self-retaining retractor.
  3. Perform blunt dissection through fascia using Metz or Harmonic scalpel.
  4. Divide strap muscles with Harmonic scalpel, move to small Richardsons, and use clips/ties to divide structures.
  5. Protect laryngeal nerve and remove thyroid with Harmonic scalpel.
  6. Place thrombin mesh in cavity to prevent bleeding. Close incision in layers to avoid thick scarring.

2 responses to “Thyroidectomy”

  1. rachel Avatar
    rachel

    That is actually a senn retractor not a freer skin hook on the mayo stand.

    1. Good eye! The picture does show Senns and not Freer skin hooks. For shallow retracting in a delicate surgery like a thyroidectomy, either Senns or skin hooks could be used. It’ll mainly be up to the surgeon! Some may see skin hooks as too aggressive and opt for more of a dull option like the Senns.

      When the setup was written, that is how the doctor performed it. The picture came later and was set up by a different tech for a different doctor. I do feel the setup should include both the Senns and Freer skin hooks even though only one is often used by the doctor. Setup updated!

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