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Total Thyroidectomy

By the use of neuromonitoring of the recurrent laryngeal nerves

1. The upper skin flap is elevated and stitched to the drapes. Separation of the strap muscles along the midline. (Patients head at the left of the picture).

2. Detachment of the strap muscles from the anterior surface of the thyroid gland. (Patients head at the left of the picture)

3. Dissection, ligation, and transection of the left superior thyroid vessels. (Patients head at the left of the picture)

4. Dissection, ligation, and transection of the right superior thyroid vessels. (Patients head at the right of the picture)

5. Beginning dissection along the tracheo-oesophageal groove in order to identify the left recurrent laryngeal nerve.

6. Identification of the left recurrent laryngeal nerve (between the arms of the forceps)

7. Stimulation of the found strand of tissue to verify its identity.

8. Right side (the head at the left of the picture). Identification of the recurrent laryngeal nerve (between the arms of the forceps). Lateral to the nerve, the inferior thyroid artery is seen.

9. Dissection and preparations to ligate the right inferior thyroid artery (head at the left of the picture)

10. Identification of the right superior parathyroid gland (at the tip of the forceps).

11. Completion of the procedure, insertion of a Penrose drain, and suture of the strap muscles along the midline

12. Suturing the subcutaneous tissues brings the skin edges close together. Use of adhesive tapes.