Scribd Logo
Upload

Welcome to Scribd!

  • 34 views

    Total Thyroidectomy: Wanda Gusta Rai (168070101011003)

    Uploaded by

    WaNda Gr
    This document provides information about the surgical anatomy and technique for total thyroidectomy. It describes the anatomy of the thyroid gland including its location, size, lobes, and blood supply. It discusses the surgical indications for total thyroidectomy and contraindications. The technique involves making an incision in the neck, mobilizing the thyroid gland, ligating the superior, middle, and inferior thyroid vessels and identifying and preserving the recurrent laryngeal nerve and parathyroid glands. Post-operative care involves monitoring the patient and treating any complications such as bleeding, nerve injury, or infection.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Total Thyroidectomy: Wanda Gusta Rai (168070101011003)

    Uploaded by

    WaNda Gr
    34 views51 pages
    This document provides information about the surgical anatomy and technique for total thyroidectomy. It describes the anatomy of the thyroid gland including its location, size, lobes, and blood supply. It discusses the surgical indications for total thyroidectomy and contraindications. The technique involves making an incision in the neck, mobilizing the thyroid gland, ligating the superior, middle, and inferior thyroid vessels and identifying and preserving the recurrent laryngeal nerve and parathyroid glands. Post-operative care involves monitoring the patient and treating any complications such as bleeding, nerve injury, or infection.

    Original Title

    Thyroid WAG.pptx

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document provides information about the surgical anatomy and technique for total thyroidectomy. It describes the anatomy of the thyroid gland including its location, size, lobes, and blood supply. It discusses the surgical indications for total thyroidectomy and contraindications. The technique involves making an incision in the neck, mobilizing the thyroid gland, ligating the superior, middle, and inferior thyroid vessels and identifying and preserving the recurrent laryngeal nerve and parathyroid glands. Post-operative care involves monitoring the patient and treating any complications such as bleeding, nerve injury, or infection.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    34 views51 pages

    Total Thyroidectomy: Wanda Gusta Rai (168070101011003)

    Uploaded by

    WaNda Gr
    This document provides information about the surgical anatomy and technique for total thyroidectomy. It describes the anatomy of the thyroid gland including its location, size, lobes, and blood supply. It discusses the surgical indications for total thyroidectomy and contraindications. The technique involves making an incision in the neck, mobilizing the thyroid gland, ligating the superior, middle, and inferior thyroid vessels and identifying and preserving the recurrent laryngeal nerve and parathyroid glands. Post-operative care involves monitoring the patient and treating any complications such as bleeding, nerve injury, or infection.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 51

    TOTAL THYROIDECTOMY

    Wanda Gusta Rai


    (168070101011003)
    SURGICAL ANATOMY OF THYROID
    Butterfly shaped
    Brownish & red
    Ant.Traingle of neck

    U.extent- oblique
    ridge Measure-5x3x1.5 cm
    L.extent of -6th T. Weight- 20-25 g
    cartilage

    2 lobes, central
    Extension (behind) connecting isthmus
    and pyramidal
    C5-T1 vertebra
    lobe.

    Isthmus extends:
    2nd - 4th tracheal
    cartilage.
    Capsules of the thyroid gland
    It has 2 Capsules:

    •True Fibrous capsule


    • Condensed connective tissue
    • Encloses the gland
    •False fascial capsule
    • Derived from the pretrachial fascia.
    • Thickend laterally forming the lat.
    Ligament of berry which fixes the
    gland to the cricoid cartilage.
    •Surgical importance……????
    Anterior

    1. Skin &
    superficial
    fascia.

    2. Ant. Jugular
    veins.

    3. Deep fascia.

    4. Sternohyoid &
    sternothyroid
    muscles.
    Anterolateral
    1. Skin, superficial fascia &
    deep fascia.
    2. Its upper part is crossed
    by sup. Belly of
    omohyoid.
    3. Its middle part is
    coveredby sternohyoid &
    sternothyroid m.
    4. Its lower part is
    overlappedby the ant.
    Border of sternomastoid.
    Arterial supply to the gland

    Superior
    thyroid artery,
    a branch of the
    external carotid
    artery.

    the thyroid Inferior thyroid


    is supplied artery; a branch
    Accessssory of the
    thyroid artery with arterial thyrocervical
    blood from trunk.

    Thyroid ima
    artery:
    subclavian
    artery/ arch of
    aorta.
    Superior thyroid veins,
    emerges from the apex of each
    lateral lobe, draining in the internal
    Venous jugular vein.
    Middle thyroid veins,
    blood emerges from the lower part of
    each lat. Lobe.
    drained Inferior thyroid veins,
    emerges from the isthmus & lower
    via: part of the lat. Lobe. draining via the
    plexus thyreoidea impar in the left
    brachiocephalic vein.
    Surgical anatomy – cont’d

    • External laryngeal nerve:


    • Branch of SLN runs close to superior
    thyroid artery.
    Important • Related to upper pole, supply to CTM
    • Injury produces voice weakness
    nerves in • Recurrent laryngeal nerve:
    relation • Branch of vagus nerve
    • Related to lower pole of gland
    to thyroid • It runs upwards in the tracheo
    esophageal groove, on posteromedial
    surface of thyroid
    • Injury produces vocal cord paralysis.
    Lymphatic System
    INDIKASI PEMBEDAHAN

     Struma difusa toksik gagal medikamentosa.

     Struma uni/multi nodusa susp keganasan.

     Struma multinodusa dengan penekanan ke


    jaringan sekitarnya.

     Kosmetik.
    KONTRA INDIKASI PEMBEDAHAN

    Struma toksik tanpa persiapan.

    Struma dengan dekompensasi kordis atau


    penyakit sistemik yang belum terkontrol.

    Struma besar yang inoperabel (biasanya


    anaplastik karsinoma).

    Struma yang disertai VCSS.


    Jenis operasi struma
    12
    ■ Lobektomi total (hemitiroidektomi; ismolobektomi) 
    pengangkatan satu sisi lobus tiroid
    ■ Tiroidektomi subtotal  pengangkatan sebagian tiroid yang
    mengandung jaringan patologis meliputi kedua lobus tiroid
    ■ Tiroidektomi near total  pengangkatan seluruh lobus tiroid yang
    patologis berikut sebagian besar lobus tiroid kontralateralnya
    ■ Tiroidektomi total  pengangkatan seluruh kelenjar tiroid
    Lobektomi total/isthmolobektomi/
    13
    Isthmusektomi/hemitiroidektomi
    14
    Bilateral STT
    15
    Near Total Tiroidektomi
    16
    Total Tiroidektomi
    TIROIDEKTOMI
    Principle of Thyroidectomy

    Prevent injury to RLN &


    ELN

    Preservation of
    parathyroid gland & its
    vascularities

    Ligation of vessels in
    order of MTV> ITA
    >STA > STV > ITV

    Meticulous technique

    Absolute haemostasis
    Avoidance of mass
    ligation
    General anaesthesia + ET
    Intubation
    • Position of patient:

    – Supine position

    – Neck elevated (15 to 30 degree)

    – Neck slightly hyperextended

    – Sand bag under shoulder

    – Foot end slightly down


    Preparing the part:
    –The entire front of neck, from jaw line to nipples, is
    cleaned with Cholorhexidine, and Betadine
    • Draping:
    – Sterile sheets are draped above, below
    and on either sides of neck, keeping
    only neck portion visible.

    – Protection of the eyes


    – Some surgeons prefer to cover this area
    with self-adhesive sheet to enhance sterility.
    23
    TEHNIK OPERASI
    ■ Insisi kolar 2 cm dari incisura jugularis sepanjang ±10 cm
    (tergantung besar kecil tumor/batas sternocleidomastoideus
    D/S)
    Insisi menggunakan
    mess hingga
    subcutan, dilanjutkan
    hingga platisma

    24
    Bilamana perlu, vena
    superfisial dapat
    dipotong

    25
     Platisma dibebaskan dari strap
    muscle ke cranial hingga os hyoid
    dan ke bawah hingga jugular
    notch
     Dibuat flap pada level fasia koli
    superfisialis keatas dan flap yang
    lain kebawah
     Flap diteugel

    26
    27
    28
    ■ Strap muscle
    dibebaskan secara
    tajam ke arah lateral
    D/S

    29
    ■ Tiroid dimobilisasi
    menggunakan kedua
    jari telunjuk secara
    hati-hati

    30
    31

    ■ Strap muscle dapat


    dipotong utk mendapat
    ekspose yang cukup
    ■ Diseksi pole atas tiroid
    dan kartilago krikoid 
    ekspose pedikel superior
    32
    ■ Identifikasi a. dan v. tiroidea
    superior pada pole atas 
    klem  potong  ligasi dng
    benang sutera 2-0
    33
    ■ V. Tiroidea media
    dipotong kemudian
    diligasi

    34
    ■ N. laryngeus rekuren
    berjalan pada sulkus
    trakeoesofagus dari bawah
    keatas menyilang di profunda
    a. tiroidea inferior masuk ke
    laring daerah krikotiroid
    sebelah belakang (dilihat
    variasi arterinya)

    35
    ■ A. tiroidea inferior
    kemudian dipisahkan
    dari N. laryngeus
    rekuren

    36
    ■ Identifikasi kel. paratiroid
    bagian atas yg terletak
    posterolateral dari tiroid 
    dibebaskan dan dibiarkan
    pada carotid sheath

    37
    38
    ■ Identifikasi A. tiroidea inferior,
    diklem lalu dipotong dan ligasi
    dengan benang sutera
    2-0

    39
    ■ V. tiroidea inferior
    pada pole bawah juga
    diligasi dan dipotong

    40
    41
    ■ Digunakan klem pada tiroid
    diatas n. rekuren, paratiroid
    dan jaringan tiroid disisakan
    satu ruas jari kelingking
    penderita.
    ■ Istmus dibebaskan dan
    dipotong.

    42
    ■ posisi leher
    dikembalikan
    ■ Insersi drain, strap
    muscle dijahit kembali

    43
    ■ Penjahitan strap muscle
    dengan jahitan kontinyu/jelujur
    ■ Fasia colli superfisial dijahit
    ■ Jahit lemak subkutan dan
    kulit(subkutikuler).
    ■ Saat ekstubasi,lihat pita suara

    44
    45
    Catatan :

    Pada waktu ekstubasi, perhatikan kembali keadaan pita


    suara dengan melihat laring menggunakan laringoskop,
    adakah parese/asimetri pada korda vokalisnya.

    Apabila kelenjar paratiroid ikut terangkat, sebelum


    menutup luka operasi, kelenjar ditanam (replantasi) di
    m.sternokleidomastoideus dengan jahitan catgut.
    PERAWATAN POST OPERASI

     Sadar Baik  Makan-minum sedikit-sedikit.

     Observasi keluhan dan VS serta produksi drain setiap jam.

     Bila hemodinamik stabil, infus dapat dicabut dan mobilisasi.


     Terapi oral :

    Analgetik,

    CDR 1 x 1 tab.

     Rawat luka pada hari ke-2, evaluasi luka operasi, drain dicabut bila
    produksi < 10-15 cc.

     Follow up mengenai penyakitnya sesuai protokol kelainan / hasil PA.


    PERAWATAN POST
    KOMPLIKASI OPERASI
    POST OPERASI

    Komplikasi dini :

    Perdarahan.

    Paralisis n.rekuren laringeus dan n.laringes


    superior (“vocal fatique”).

    Trakeomalasia (stridor inspirasi).

    Infeksi luka operasi.

    Komplikasi metabolik 
    Komplikasi lanjut :
    Keloid luka operasi.

    Hipotiroid 
     Evaluasi TSH, FT4.

     Thyroxin oral.
    REFFERENCE
    • Jacobs, L.M., Luk, S.S., 2010. Advanced Trauma Operative Management. 2nd ed. CineMed. Canada.

    • Mattox, et al. 2013. Trauma. 7th ed. Mc Graw Hill. New York.

    • Mc.Aninch JW; Surgery for Renal Trauma. in Novick, A.C., Streem, S.B., Pontes, J.E.. Stewart’s Operative
    Urology. Baltimore. Williams & Wilkins Urology. 1989:234-9

    • Metro J.M., Mc Aninch, J.W., 2003. Surgical Exploration of the injured kidney: Current Indications and
    Techniques. Int bras urol. vol.29 no.2 Rio de Janiero.

    • Skandalakis L.J., 2014. Surgical Anatomy and Technique. 4th ed. Springer. New York

    • Summerton et al, 2015 Guidelines on Urological Trauma EAU

    • Williams, N.S., Bulstrode, C.J., 2008. Bailey & Love’s Short Practice of Surgery. 25th ed. Hodder Arnold.
    Great Britain

    • Zaid, U.B, et al. 2015. Penetrating Trauma to the Ureter, Bladder and Urethra. Curr Trauma Rep 1:119-124

    • Zollinger, R.M., Ellison, E.C., 2011. Atlas of Surgical Operations. 9th ed. Mc Graw Hill. New York.
    THANK YOU

    You might also like