Oct 21, 2008
Surgeon: Gregory J. Roscoe MD
PREOP DIAGNOSIS: Right thyroid mass approximately 1.8 cm. skinny needle biopsy benign.
POSTOP DIAGNOSIS: Same, with an area less that 5 mm, could be papillary carcinoma variant.
OPERATION/PRODECURE: Right subtotal thyroidectomy with recurrent nerve dissection and Stryker drain place and secured. Frozen section.
TECHNIQUE: The patient was brought to the operating room and identified. Under endotracheal anesthesia the patient was adequately anesthetized. On evaluation of the neck, the patient did have fullness to the right lobe of the thyroid. The patient was prepped and draped in the usual sterile manner. A curvilinear incision was then made and taken down through the skin and subcutaneous tissues. Strap muscles were divided in the midline. Overall, dissection was then carried into the right lobe of the thyroid. The patient had a lrge mass as noted, approximately 2 cm within the lobe of the thyroid, and a small additional lobe perithyroid; apparently a benign looking parathyroid adenoma. The right lobe was dissected in the usual fashion dissecting in the midline as well as sacrificing the superior, middle and inferior lobe vasculature as well as identifying the recurrent nerve and following it to insertion in the lateral aspect of the larynx. The left lobe, overall, felt extremely soft and regular even though scanning revealed some nodularity. At that poin the lobe was submitted. A small parathyroid was reimplated on the right side. At that point the frozen section revealed a benigh adenoma within the thyroid. However, the adjacent piece appeared to be, at this point, difficult to call but a variant of papillary carcinoma. Further studies are pending. A small bit of Arista was placed as well as a Stryker darin was placed and secured with 2-0 silk. Closure was accomplised with mattress stitches of 3-0 chromic as well as skin staples. A pressure dressing was placed as well as foam tape used.