DATE: @TD@
PATIENT NAME: @NAME@ 


PREOPERATIVE DIAGNOSIS: 
***

POSTOPERATIVE DIAGNOSIS: 
Same

OPERATION: 
***

SURGEON: William Morrel, MD 

ANESTHESIA: General 

INDICATIONS FOR PROCEDURE:  
***

FINDINGS:  
***

DESCRIPTION OF PROCEDURE:
Patient was identified in holding room. The neck was marked ***. H&P updated. Taken to OR suite and induced and intubated with NIMS ETT without complication. Grounding electrodes placed and NIMS machine with appropriate confirmatory signals. 7 cm incision marked in midline. Prepped and draped in a sterile fashion. 

Time out performed. Skin incised with 15 blade and taken through platysma. Subplatsymal flaps elevated to hyoid superiorly and sternal notch inferiorly. Straps separated in midline with monopolar cautery and the mass quickly came into view. Straps separated off mass cleanly with bipolar cautery and isthmus identified in midline. Cricoid identified with sharp dissection superiorly and trachea inferiorly and isthmus undermined and divided with harmonic forceps. The cricothyroid muscle was then identified superolaterally and thyroid lobe on right pulled down and medially. Tissue between thyriod capsule and cricothyroid seperarted with harmonic forceps and I kept dissection in this fashion pulling down the superior lobe and dividing superior pole vessels with the harmonic and placed a clip on the superior thyroid vein and artery as further insurance for hemostasis. Once the lobe was freed I kept dissecting around the lobe inferiorly and identified and ligated the middle thyroid vein. The posterior lobe was then dissected with blutn dissection and harmonic forceps inferiorly, now coming back up superiorly, diving inferior thyroid vessels with the harmonic. Eventually the gland was delivered out of the neck and dissection continued carefully with McCabe forceps and bipolar. The RLN was identified int he soft tissue of the parathyroid bed and dissected until it entiered the larynx. Stimulated. Now with the RLN identified, we continued removing the gland from the surrounding connective tissue with harmonics and bipolar forceps. Eventually it was freed from its attachments to the trachea in a similar fashion and handed off as specimen. Wound irrigated. RLN still stimulated. Fibrillar placed over area of RLN were there was some mild oozing. 15F Blake drain placed and brought out lateral to the *** edge of incision . Straps closed with 3-0 vicryl interrupted. Then subplastysmal layer closed with interrupted 3-0 vicryl. Skin closed with deep dermal 4-0 Monocryl. Steri strips and mastisol placed. Grounding electrodes removed. Drapes removed. Patient returned to anesthesia. The patient emerged and was extubated without complication. She was taken to the PACU in stable condition. Of note, both superior and inferior parathyroids candidates identified during dissection and preserved.

ESTIMATED BLOOD LOSS: *** mL
 
COMPLICATIONS: None ***

SPECIMENS: ***

DISPOSITION:
The patient was transferred to the recovery room in stable condition.