Table 1.

Summary of surgical technique for thyroidectomy

Positioning and draping	Reverse Trendelenburg with neck extended Transparent plastic drape helps monitor endotracheal tube and anesthesia circuit
Surgical incision	Vary location and length depending on body habitus and exposure required
Cutaneous flaps	Elevate in the subplatysmal plane
Management of strap muscles	Retraction without division for accessible superior pole Division at superior attachment for inaccessible superior pole Segmental muscle resection if suspected or gross invasion by tumor Division of both strap muscles for huge retrosternal goiter
Superior pole dissection and preservation   of ESLN	Ligate individual branches of the superior thyroid artery anterior to the pole to avoid injury to parathyroid and ESLN Avoid mass ligature of superior pedicle and excise all thyroid tissue
Capsular dissection and preservation   of PT glands	Use fine-tipped clamps for dissection Ligate branches of ITA on the thyroid capsule distal to the PT gland to ensure preservation of the blood supply to the PT glands
Identification of RLN	Avoid lateral dissection for identification of RLN in paratracheal groove as the initial step Recognize variations in normal anatomy relative to tracheoesophageal groove, branches of the ITA, tuberculum Zuckerkandl, and Berry’s ligament Anticipate distortions in normal relationship of RLN to adjoining structures due to tumorand Berry’s ligament
Hemostasis, drains, and wound closure	Avoid suction drain Layered wound closure
Postoperative care	Monitor airway Monitor neck wound for hematoma Monitor blood work for hypocalcemia