Surgery setup images for Thyroidectomy

Thyroidectomy-mayo-setup

Mayo stand and back table instruments for Thyroidectomy surgery setup

Clamping & Occluding

  • Allis Forceps

    Allis Forceps

  • Kelly Forceps

    Kelly Forceps

  • Mosquito Clamp – Curved

    Mosquito Clamp – Curved

  • Rienhoff Swan-Neck Clamp

    Rienhoff Swan-Neck Clamp

  • Right Angle Clamp

    Right Angle Clamp

Cutting & Dissecting

  • #3 Knife Handle

    #3 Knife Handle

  • Potts Tenotomy Scissor

    Potts Tenotomy Scissor

  • Straight Mayo Scissor

    Straight Mayo Scissor

Grasping & Holding

  • Adson Forceps

    Adson Forceps

  • Debakey Forcep

    Debakey Forcep

  • Smooth Adson

    Smooth Adson

Retracting & Exposing

  • Freer Skin Hook

    Freer Skin Hook

  • Mahorner Thyroid Retractor

    Mahorner Thyroid Retractor

  • Richardson Retractor

    Richardson Retractor

  • Weitlaner Retractor

    Weitlaner Retractor

  • Senn Retractor

    Senn Retractor

Suctioning

  • Ferg-Frazier Suction

    Ferg-Frazier Suction

  • Yankauer Suction

    Yankauer Suction

Suturing & Stapling

  • Mayo-Hegar Needle Holder

    Mayo-Hegar Needle Holder

  • Ryder Needle Holder

    Ryder 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 thoughts on “Thyroidectomy

    • Joshua Roosevelt says:

      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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