How is a thyroidectomy performed? How is a subtotal thyroidectomy performed? Operations on the thyroid gland: indications, types and conduct, rehabilitation.

The date: 18.08.2020

Infectious complications are extremely rare.

How is open surgery performed?

Surgery on the thyroid gland

Under general anesthesia, a collar-shaped incision is made on the anterior surface of the neck a few centimeters above the jugular incision of the sternum.

The length of the incision depends on the planned intervention, with a hemithyroidectomy (that is, when only a lobe is removed), it will be less than with a thyroidectomy, and also depends on the volume of the thyroid gland. It can reach 10-12 or more centimeters.

The incision line for surgical intervention on the thyroid gland is indicated in red

Next, the right and left lobes of the gland are isolated, examined for the presence of nodular formations. If the formation turned out to be larger than according to preoperative diagnostics, or growth to the capsule of the thyroid gland was found, then intraoperatively a decision can be made to change the tactics of treatment and remove the gland entirely.

The surgeon carefully bandages each vessel supplying the thyroid gland or its share, allocates and preserves the recurrent laryngeal nerve, parathyroid glands.

At the end of the operation on the thyroid gland, as a rule, drains are left (pictured below) for several days to control the amount and nature of the discharge. The drainage is removed in the dressing room, anesthesia is not required.

What does the drainage system look like after surgery?

Minimally invasive video-assisted thyroid surgery.

Indications:

Nodular formation of the thyroid gland
The thyroid gland is responsible for the storage (accumulation) of iodine in the human body and for the production of iodine-containing hormones. Due to this, the normal functioning of the body is maintained. The thyroid gland has no excretory ducts, and the secret of its glands is absorbed into the blood.

There are a number of diseases in the presence of which it is necessary to immediately remove the thyroid gland. However, the consequences of such an operation can be the most unpredictable, which often frightens many patients.

Before the operation, it is necessary to conduct a comprehensive examination of the patient, according to the results of which the doctors realistically assess both the consequences of the disease and the consequences of the removal of the thyroid gland, and make their choice in favor of the action, after which there will be fewer complications. If the thyroid gland or part of it has been removed, the body tries to rebuild its work. During this, a violation of metabolic processes occurs, the physical and mental state of a person worsens.

In addition, even at the planning stage of the operation, it is necessary to identify additional lobes of the thyroid gland (they can be located separately) and, after the main part of the organ has been completed, take on full or partial performance of the function. It must be remembered that the removal of a large part of the functionally active tissue of the thyroid gland inevitably leads to the development of hypothyroidism, the severity of which will depend on the amount of hormones that will be synthesized in the body after surgery.

According to statistics, most of the world's population suffers from thyroid dysfunction. If treatment was started on time, doctors would be able to cope with a significant part of the diseases in a relatively short time. With an increase in the thyroid gland, especially if there is a suspicion of the development of a tumor process in the organ, some doctors prescribe an early removal of it.

However, such an action is often unjustified, and a person gets severe consequences of the operation for life. If thyroid diseases are benign and have a mild course, the doctor may limit himself to prescribing drug therapy aimed at restoring the normal functioning of the organ. For the prevention of iodine deficiency conditions, experts recommend taking special vitamins.

In modern conditions, doctors insist that the main indications for removal of the thyroid gland should be its complete destruction as a result of trauma (this condition is actually extremely rare) or if nodular formations are detected in the tissue of the organ, for which their malignant nature is confirmed.

In the presence of diseases of the thyroid gland, it is forbidden to self-medicate. Only a doctor can determine your condition and the severity of the disease. Taking herbal infusions should be started only after consulting a doctor.

The most dangerous diseases of the thyroid gland for women. After all, against their background, there are many other "female" ailments that have a negative impact on the reproductive system. In addition, the development of serious female diseases implies the need for examination of the thyroid gland and consultation with an endocrinologist.

If the operation to remove the thyroid gland or part of it is successful, the body recovers and the normal functioning of all vital systems resumes. However, it is necessary to maintain hormonal balance afterwards, as the function of the thyroid gland decreases after the operation. The doctor will prescribe special drugs that can replenish the function and maintain the balance of hormones. After the operation to remove the gland, it is necessary to constantly be under the supervision of a specialist. In cases where the patient does not follow the doctor's recommendations, the thyroid gland malfunctions, the general condition of the body worsens, which leads to disastrous consequences.

Any operation, including the operation to remove the thyroid gland or part of it, may be accompanied by complications. As a rule, some are quite rare, but they do occur in some patients. One of the most common early postoperative complications is recurrent nerve injury. Almost every patient going for surgery knows about this complication. The complication is successfully treated under the guidance of an experienced doctor.

After removal of the gland, dysfunction of the parathyroid glands may appear. With such a diagnosis, the doctor prescribes drug therapy. Sometimes it can last for life.

One of the rarest consequences of surgery is bleeding. The probability of its occurrence is 0.2%. Another rare complication is suppuration of the surgical suture. Occurs in 1 case out of 1000.

NB: It is important to remember that drug replacement therapy with thyroid hormones in a dose selected by a doctor should be carried out for life - this allows you to ensure the normal functioning of the patient's organs and systems.

According to statistics, thyroid diseases occur in every second inhabitant of the planet, taking 2nd place after diabetes. Pathology of the thyroid gland is always dangerous, but with timely treatment it is completely curable.

Often people do not pay attention to the first manifestations, which last long enough, and go to the doctor when the disease becomes more complicated. Often in such cases, conservative treatment is inappropriate and one has to turn to radical methods of treatment. Removal of the thyroid gland is a rather complicated operation, but it is often carried out and quite successfully. The patient should know in what cases it is possible to talk about the restoration of the gland, and when this is not possible and an operation is required?

The thyroid gland is the largest of the endocrine glands, projecting near the thyroid cartilage, just above the jugular notch. It consists of 2 symmetrical lobes connected by an isthmus. Regulates all types of metabolism and is responsible for bone strength. Any system in the human body is associated with the thyroid gland. Pathologies of the thyroid gland are 4-5 times more typical for women.

What is the SC responsible for? For metabolic rate, muscle tone and skeletal system, intellectual development of children; for normal MC in women and indirectly for their fertility, potency in men, human emotions, thermoregulation, hematopoiesis and cellular respiration.

Thyroxine contributes to the normalization of the entire hormonal background in the body. As consequences, otherwise, an imbalance of all hormones develops. In the full sense of the word, this is why endocrinologists often consider the thyroid gland to be an ubiquitous organ. Violations of its work can be both in the form of an increase in the production of hormones, and their insufficient synthesis.

Provoking factors include the following:
- bad ecology;
- iodine deficiency;
- stress;
- pituitary tumors;
- complications of chronic diseases of other organs and systems;
- improper nutrition.
The thyroid gland should be examined for its disease only by an endocrinologist. Mood instability is often the first sign of hyperfunction. Along with this, there is sweating, tachycardia, a feeling of heat, increased appetite, weight loss.

Outwardly, such people do not look like patients, they have a blush on their cheeks, expressive shining eyes due to the expansion of the palpebral fissure, velvety skin, they seem younger than their years. The expressiveness of the eyes eventually gives way to bulging eyes, the upper eyelid cannot completely cover the eye. The look is angry.

On the part of the internal organs, they often have diarrhea, cardiopathy, increased blood pressure, shortness of breath, and fatigue. If all this continues, heart failure develops.

With hypofunction, the speed slows down in everything: a person becomes slow, drowsy, gains weight, thinking and speech are inhibited. The pulse is reduced, there is bradycardia and a decrease in blood pressure.

In diseases of the thyroid gland, a goiter often develops, which, with its growth, can squeeze the trachea and esophagus, disrupting swallowing and breathing.

The thyroid gland is so important for the body that the question involuntarily arises: is it possible to live if the thyroid gland is removed? Yes, it is possible, but such a patient must take hormones replacing it for life.

In what cases is the removal of the thyroid gland required? These questions can be answered by the receptionist. Thyroid surgery: what is the name of the removal? Thyroidectomy or extirpation. Upon examination, the doctor can immediately determine the presence of indications and contraindications for ectomy.

The operation to remove the thyroid gland is indicated:
- upon detection of oncology of the thyroid gland;
- with the ineffectiveness of conservative treatment for hyperthyroidism, which turned into thyrotoxicosis with a serious condition;
- an operation to remove the goiter of the thyroid gland - a nodular size of more than 3 cm or diffuse;
- with recurrence of the cyst;
- with retrosternal goiter, which compresses the mediastinum;
- the operation should also be performed in case of thyroid injury with its total destruction;
- with the growth of goiter with impaired breathing and swallowing;
- in case of cosmetic defects;
- fine needle biopsy evidence that suggests proliferation;
- with increased synthesis of thyroid hormones with the inability to use RIT (allergy);
- with calcification of the thyroid parenchyma, which indicates an increased risk of carcinoma.
The prognosis after removal of the thyroid gland is mostly favorable, even in the case of oncology - it can be cured completely.

The gland can be removed completely or partially, depending on the degree of damage. Thyroid gland: how long does the operation take? The removal operation is performed within 40 minutes to 1.5 hours, under anesthesia. The seams after it are almost invisible. The operation is performed in the classical way or endoscopically.

So, the contraindications include:
1. Benign neoplasm such patients should be treated as conservatively as possible. And only if this has not passed, the operation is indicated.
2. The advanced age of the patient is always an obstacle for operations, such patients can be recommended not to operate on the gland, but to undergo RIT (radioactive iodine treatment), for which age does not give restrictions.
3. Severe infections, active TB, severe diabetes, liver and kidney failure, exacerbation of chronic pathologies.
What threatens the removal of the thyroid gland? Of course, the intervention of surgeons cannot pass without a trace.

Since the thyroid gland is no more, the metabolic processes slow down in the first place. Body weight begins to increase. Therefore, a low-calorie diet is recommended to start with.

Also, the consequences: drowsiness, loss of strength, decreased mood, constant fatigue - the result of a deficiency of thyroid hormones. The doctor prescribes in these cases hormone replacement treatment (for life). Hormones are necessary because otherwise a hypothyroid coma with a fatal outcome will simply develop.

Another consequence of the operation is damage to the laryngeal nerve - in whole or in part. Then a violation of the sensitivity and motor activity of the larynx may develop. This will result in a loss of voice. With partial damage, all violations are reversible. Also, during the operation, the parathyroid glands responsible for phosphorus-calcium metabolism can be damaged. Treatment is symptomatic.

Removal and preparation for surgery of the thyroid gland: a thorough examination of the body is carried out:
- testing for T3, T4, TSH;
- UAC and OAM;
- definition of oncomarkers;
- blood biochemistry;
- when affected by nodes, a special biopsy of the thyroid nodes is made with a thin needle by aspiration.
According to a satisfactory condition, the therapist's permission is given for an operation to remove the thyroid gland and the patient signs a warning regarding the risks. Patients with thyrotoxicosis prepare for several weeks before euthyroidism (hormone levels are normal).

There are several methods for conducting operations:
1. Thyroidectomy(total removal) - complete removal of the thyroid gland (for cancer). This is determined by the pathology and the degree of violations. Subtotal thyroidectomy - not one lobe is excised, but most of the parenchyma, except for the area of the parathyroid glands. This is done with diffuse goiter.
2. Lobectomy(removal of the entire lobe of the thyroid gland or removal of the jumper) - is done when the gland is damaged on one side.
3. Neck lymph node dissection- the name of the operation, which is performed on the cervical lymph nodes, more often with oncology.
4. Thyroid resection - partial removal of one lobe of the thyroid gland (its affected tissue).
5. Hemithyroidectomy half of the organ is removed.
6. Radical surgery - performed in oncology - complete excision of lymph nodes, tissue and neck muscles. When operating on such patients, it is desirable to leave at least part of the parenchyma. With intrafascial removal, when the fascia of the neck is not touched, usually complications in the form of damage to the laryngeal nerve and parathyroid glands are excluded. Surgery is quite successful in this.
7. Intracapsular method- used for single nodes. Extrafascial option - the most traumatic, used only for thyroid cancer.
The tissues of the removed gland must be sent for histology. With Graves' disease, the share of the gland, the isthmus is completely removed, and the second share is partially. Operations to remove the thyroid gland can also be done endoscopically - small incisions reduce trauma.

When is the patient hospitalized? The hospitalization of the patient is appointed one day before the operation. The last meal is 12 hours before the operation, sedatives are used.

How is the operation going? The patient is given general anesthesia. Technically, the operation is simple, but laborious. First, a transverse incision is made on the neck of 6-8 cm, the subcutaneous fat is also cut and the thyroid gland is examined to select the tactics of the operation. In the presence of cancer, regional tissues are examined to detect metastases - then the incision is deepened.

According to the degree of damage, part of the share, 1 or 2 shares can be removed at once. After removal, stitches are applied and the wound is sutured.

The incision area is lubricated with special compounds that will prevent scarring and help the fastest healing. Sometimes a drain is left in the wound to prevent swelling and can be removed the next day.

Although the discharge is made on the 2-3rd day, for some time the patient visits the doctor and undergoes additional examinations. The postoperative period takes no more than 10-12 days; with the endoscopic method - 2-3 days.

After removal of the thyroid gland, the consequences are not particularly noticeable with the constant use of hormones. Activity, the possibility of conception and childbirth are preserved. Patients are observed for life by an endocrinologist.

Removal without surgery In addition to RJT, there are some other non-surgical methods of removal. These are methods of interstitial destruction. Indications for them: nodule on the thyroid no more than 3 cm, recurrence after surgery, cyst up to 4 cm, unwillingness of the patient to be operated on. Contraindications: mental disorders and severe somatics. During the preparation period, the analyzes are the same.

The method of ethanol sclerotherapy - alcohol is injected into the tissue of the node, which scleroses the vessels. Another method is thermotherapy by laser induction and thermal destruction by radio frequencies. The advantage of these methods is that the effect on the affected area is precisely targeted.

This is especially valuable for the elderly. After 60 years, the appearance of nodes on the gland is a frequent and normal phenomenon. At the same time, thyroxine is produced in an increased amount and the activity of the cardiovascular system and central nervous system is disrupted. Since surgical intervention in the elderly is often burdensome, methods of destruction are used. They do not scar, are performed on an outpatient basis and are painless.

After the operation, when the effect of anesthesia ends, patients feel pain on the front of the neck - this is normal. There may be non-specific - this is the name of the usual general - conditions: hyperemia and swelling of the seam, suppuration and bleeding, with damage to the ligaments and muscles - restriction of mobility of the neck, with the introduction of a tracheal tube during anesthesia - hoarseness of voice - all these conditions are temporary and pass with symptomatic treatment.

Specific complications - when the laryngeal nerve and parathyroid glands are affected. If these glands are accidentally removed, hypocalcemia develops with a feeling of paresthesia of the legs and convulsions.

The goal of treatment is to eliminate hypocalcemia. Calcium preparations are prescribed.

A scar in the form of a thin light strip on the throat is formed after 2-4 weeks. By the end of the month, there is no redness, swelling and discharge.

When the thyroid gland is removed, hormone replacement therapy is started already in the hospital, the drugs are administered parenterally - their use is necessary.

Extract occurs on the 3-7th day. Then the patient is under outpatient supervision of a doctor in the clinic. The duration of the outpatient phase is 1-3 months, at which time chronic diseases may worsen. After this period, the sick leave is closed.

Specific complications at this time: periodic rise in temperature, change in heartbeat in any direction, drowsiness, fatigue, loss of appetite, or completely opposite conditions + dry skin, hair loss, rash, weight fluctuations. These consequences are not at all obligatory and indicate the need to adjust the dose of thyroxin, they should not be tolerated.

After the outpatient phase, there is a period of self-monitoring. 2 times a year it will be necessary to visit the endocrinologist. If the thyroid gland is removed, hormones are taken for life.

Thyroid surgery - quite a traumatic procedure, both physically and emotionally. What you need to know when thyroid surgery is scheduled? You will find the answer in this article. Hello, dear readers of the blog "Hormones are normal!".

Since you have landed on a page that is dedicated to the surgical treatment of the thyroid gland, then the situation is really serious. Agree that any operation is done only for special indications. I'm sure you know the paraphrased expression "The most successful operation is the one that is not done." Therefore, you should try to use all possible conservative methods of treatment.

To begin with, this type of treatment is not carried out by everyone. There are strict indications for this procedure:
- thyroid cancer
- Suspicion of thyroid cancer
- Diffuse toxic goiter
- Functional autonomies (multinodular toxic goiter, toxic adenoma)
- Large goiter with symptoms of compression of the trachea and esophagus
Well, with thyroid cancer, everything is clear. This diagnosis is based on the conclusion of a fine needle aspiration biopsy (FNA). When doctors doubt whether there is an oncological disease or not, they prescribe a so-called diagnostic operation.

During the operation, the tissue of the altered gland is taken and an urgent histological examination is immediately carried out. If cancer is detected, the operation continues according to the rules of operations for oncological diseases. If oncology is not confirmed, then, as a rule, only one lobe or only a separate section of the altered tissue is removed.

Surgical treatment for diffuse toxic goiter is prescribed mainly after unsuccessful drug therapy. But it is possible to use this method as the main one. It is used in case of early pregnancy planning in young patients, and also if the patient himself expresses a desire to have an operation. What other methods are used in the treatment of this disease, read the article "Three effective methods for the treatment of DTG".

A direct indication for surgery is the detection of functional autonomy (multinodular toxic goiter, toxic adenoma). Conservative therapy in this case is absolutely ineffective.

When there is a large goiter, it can compress nearby organs and disrupt their work. Therefore, when symptoms of compression appear, surgical treatment is also indicated in order to reduce the size of the gland. These symptoms include swallowing or breathing disorders, as well as vascular disorders due to compression of the vascular bundle.

In some cases, special preoperative preparation is required before thyroid surgery. If a patient with thyrotoxicosis is operated on, then for a start the person must be brought into a state of euthyroidism, which is achieved by prescribing thyreostatics and beta-blockers. That is, the patient should not have symptoms of thyrotoxicosis, and laboratory tests of thyroid parameters should be within the normal range.

This is necessary because if this is not done, then after the operation, a thyrotoxic crisis occurs, which can end in death. In other cases, special preoperative preparation is not required.

Depending on the indication, the volume of the operation being performed is selected. In other words, how much thyroid tissue will be removed depends on the disease that led to the operation.

In case of detection of thyroid cancer, a rather traumatic operation is performed, which involves the complete removal of the gland along with the parathyroid glands and nearby lymph nodes.

With diffuse toxic goiter, the so-called subtotal resection of the thyroid gland is performed. In other words, almost the entire gland is removed, with the exception of those areas where the parathyroid glands are located. In general, there are about 2 gr. gland tissues.

With nodes (colloidal or autonomously functioning), as a rule, only a lobe of the thyroid gland or an area with a node is removed. The second lobe remains and very often takes over the job of providing the body with thyroid hormones.

With a large goiter, as much of the gland is removed as necessary to eliminate the syndrome of compression of the trachea or esophagus.

Thyroid surgery is an invasive intervention that carries a certain risk of postoperative complications. The success of the operation largely depends on the qualifications of the surgeon. Therefore, it is recommended to operate only in specialized clinics, where there is extensive experience in thyroid surgery.

I would divide all complications into non-specific (complications that occur with any surgical intervention) and specific (complications that are typical only for operations on the thyroid gland).

The non-specific ones include:
- Inflammation in the operating wound
- Seam failure
- Bleeding
The specific ones include:
- Thyrotoxic crisis
- Recurrent nerve palsy (voice change)
- Removal of the parathyroid glands with the development of hypoparathyroidism
- Hypothyroidism
Almost every operation on the thyroid gland subsequently causes the development of hypothyroidism. If a total removal of the thyroid gland was performed, then hypothyroidism develops in 100% of cases. If only partial resection was performed, hypothyroidism will develop in 70% of cases. With the development of hypothyroidism, replacement therapy of the missing thyroid hormones with synthetic analogues is carried out. The treatment turns out to be lifelong, since most of the organ is removed.

Previously, when there were no such high-quality drugs as thyroxin preparations for replacement therapy, an extract from the glands of cattle was used. Such a drug very often caused allergic reactions, which significantly reduced its effectiveness and the quality of life of the patient.

Today we have very high quality preparations of L-thyroxine, which are practically not inferior to the human thyroid hormone in terms of action, efficiency and safety, which is why the patient's quality of life is no different from the life of a healthy person. The exception is the need for a single daily intake of thyroxin tablets, which, I think, does not particularly affect the patient's quality of life.

Read the article "How to Treat Hypothyroidism with Thyroxine Preparations" to finally understand this issue.

The dose of thyroxine is selected individually, and it turns out to be different for each patient. During life, it may be necessary to change the dose of the drug, so it is recommended to conduct a control determination of the hormones TSH, free T4 and free T3 annually.

Some patients may develop hypoparathyroidism after thyroid surgery, which, like hypothyroidism, requires replacement therapy in the form of tablets. Such patients receive calcium and vitamin D supplements. There is also an article on this topic “Treatment of hypoparathyroidism” on the blog.

With paresis of the recurrent nerve, the prognosis depends on the degree of damage to it. In some cases, the voice is restored on its own, and in severe cases, vocal cord surgery is required.

Thyrotoxic crisis occurs with inadequate preparation for surgery, if thyrotoxicosis has not been completely eliminated. After the operation, a huge amount of active hormones is released into the blood, and after a few hours a crisis may develop. Symptoms of a thyrotoxic crisis can be considered the same symptoms of thyrotoxicosis, only more severe many, many times. Ideally, after the operation, the patient should not feel them, which means that the operation was successful and the crisis has passed.

In general, patients after thyroid surgery recover fairly quickly and return to their normal lives. A barely noticeable scar remains on the neck, which can be quite small, since endoscopic methods of operations on the thyroid gland have now been developed.

And that's all I have. In my next article, I will tell you how the work of the thyroid gland affects body weight, subscribe to blog updates and receive new articles in your email. mail.

Surgical interventions on the thyroid gland include: resection, hemithyroidectomy, subtotal resection, thyroidectomy. In some malignant diseases, the thyroid gland is completely removed along with the surrounding fiber.

Indications: operations on the thyroid gland are performed for nodular goiter, regardless of the degree of enlargement of the organ and its function, nodular and diffuse thyrotoxic goiter, malignant tumors (cancer) of the thyroid gland.

With benign single nodes, the node is removed within healthy tissue (economical resection). Node ennucleation is currently not applied. With multiple nodes of unilateral localization, the affected lobe is removed along with the isthmus of the thyroid gland (hemithyroidectomy). With thyrotoxic parenchymal goiter, Graves' disease, which is not amenable to conservative treatment, most of the gland is removed, leaving small areas of its lateral lobes (2-4 g each) on the sides of the trachea, which makes it possible to preserve the parathyroid glands and the recurrent laryngeal nerve (subtotal resection operation). thyroid gland or strumectomy). Currently, the surgical tactics for toxic goiters have changed somewhat, since leaving even a small amount of gland tissue often leads to a relapse of the disease. Modern surgeons recommend leaving only part of the thyroid capsule.

During strumectomy, all thyroid arteries - upper and lower - are tied up. The latest method of subtotal, subcapsular strumectomy, developed by O.V. Nikolaev, is now widely used in our country. Thanks to its use, postoperative mortality in the surgical treatment of Graves' disease has decreased to tenths of a percent.

In anaplastic thyroid cancer, the gland is removed along with its outer fascial capsule. With this method, used when removing a tumor-affected gland, it is possible to damage the parathyroid glands and the recurrent laryngeal nerve in the so-called danger zone.

Technique of subtotal, subcapsular strumectomy according to Nikolaev (Fig. 23).

When resecting or removing the thyroid gland, a number of key points should be observed: 1) ligation of the upper and lower thyroid arteries; 2) separation of the gland from the trachea; 3) compliance with precautions when working near the recurrent laryngeal nerve; preservation of the posterior wall of the capsule of the thyroid gland with the parathyroid glands; washing the surgical wound at the end of the operation in order to prevent a thyrotoxic crisis.

The position of the patient on the back with a roller under the shoulder blades. Local anesthesia or anesthesia. The collar-shaped incision corresponds to the skin fold 1-1.5 cm above the jugular notch and is carried out between the anterior edges of the sternocleidomastoid muscles through the skin, subcutaneous tissue, m. platysma and superficial fascia. The upper skin-subcutaneous-fascial flap is dissected up to the upper edge of the thyroid cartilage. The median veins of the neck, the anterior jugular veins, located in the thickness or under the second fascia, are isolated, captured with two clamps, dissected and tied up.

The second and third fasciae of the neck are dissected longitudinally in the middle between the sternohyoid and sternothyroid muscles. Above the level of the skin incision, the sternohyoid, and with large goiters, the sternothyroid muscles are dissected in the transverse direction: a Kocher probe is placed under the muscles, two clamps are applied and the muscle is crossed between them. The thyroid gland is exposed: separately, under the capsule of the right and left lobes, 10 ml of a 0.25% solution of novocaine is injected, which not only blocks the thyroid plexus, but also facilitates the next stage - the release of the gland from its capsule.

The resection of the thyroid gland begins with the release of the isthmus and its intersection between two clamps along the Kocher probe, which separates the isthmus from the trachea. If there is a pyramidal lobe, this lobe is first cut off between the clamps. The dissected fascial capsule is bluntly shifted posteriorly to the cutting line of the right lateral lobe of the gland; dislocate from the capsule first the lower, then the upper pole of this one and cut it off. As the cutting off in small portions, the glands and blood vessels with the fibrous membrane of the gland are captured with hemostatic clamps. Having finished cutting off the right lobe, a thorough hemostasis is performed, several hemostatic clamps are captured in one catgut ligature and the stumps of the vessels located in them are tightly tightened into one knot. After careful hemostasis over the boat-shaped stump, the edges of the fascial capsule are sutured with a continuous catgut suture. The operating wound is washed with a jet of novocaine solution in order to free it from toxic products that have poured out during the dissection of the thyroid tissue.

Rice. Fig. 23. Strumectomy technique: a - the right lobe of the thyroid gland is dislocated into the wound and its outer capsule is dissected and shifted to the cut-off line of the lateral lobe; the vessels are captured by clamps: 1, 2, 5, 7 - the ends of the dissected sternohyoid muscles; 3, 6 - edges of the dissected parietal sheet of the fourth fascia; 4, 8 - sternocleidomastoid muscles; 9 - external fascial capsule of the thyroid gland, formed by the visceral sheet of the fourth fascia of the neck; 10 - own fibrous capsule of the right lobe of the thyroid gland; b - cutting off the right lobe of the thyroid gland, fixed in the wound on the finger; the imposition of catgut sutures on the edges of the fascial capsule of the right lobe was started; d - stitches on the capsule are imposed.

The same techniques remove the left lobe of the thyroid gland. After suturing the fascial capsule on its stump, the wound is again washed with novocaine solution.

Layer-by-layer suturing of the wound begins with suturing the sternohyoid muscles with catgut U-shaped sutures.

If the sternothyroid muscles were not dissected, they cover the formed stumps of the lateral lobes of the gland. The edges of the fascia are sutured with interrupted catgut sutures, the skin edges - with interrupted silk or nylon sutures. Drainage from strips of glove rubber is left in the wound for a day.

Currently, the technique of the operation has changed somewhat. With operational access, it is extremely rare, only with a significant degree of increase, that the sternohyoid muscles are crossed. The lobes of the gland are removed together with the capsule, without affecting its postero-medial wall. The intersection of the tissue of the thyroid gland is always made between the clips, and each clip is bandaged separately with a nylon.

During and after surgery, the following complications may occur: 1. Bleeding; 2. Asphyxia; 3. Removal of the parathyroid glands; 4. Damage to the recurrent laryngeal nerve; 5. Compression of the recurrent nerve by a hematoma; 6. Violation of the voice (hoarseness, aphonia); 7. Air embolism; 8. Thyrotoxic crisis.

With an increase in the size of the thyroid gland or an increase in the production of thyroid-stimulating hormones by the pituitary gland, the hormone-forming function automatically increases, which leads to an increase in the level of thyroid hormones in the blood - thyrotoxicosis. In the vast majority of patients, thyrotoxicosis is manifested by such classic symptoms as: sudden mood swings, irritability, irritability, insomnia, tremors, excessive sweating, fever, tachycardia, a subjective feeling of heart failure (arrhythmia), shortness of breath, bulging eyes, inability to concentrate on an object , sudden weight loss, diarrhea.

Indications

You can diagnose as follows:

external examination of the patient, complaints;
a blood test for the level of thyroid-stimulating hormone (TSH), thyroid hormones (T3, T4);
Ultrasound (size of the organ, its individual parts, condition of the nodes);

At the initial stages of the disease and with its slow progression, therapeutic treatment is prescribed with medications that lower the activity of the thyroid gland. In case of failure of such treatment or an advanced stage of the disease, a subtotal resection of the thyroid gland is performed - the removal of its lobe in order to reduce hormone production.

Subtotal resection of the thyroid gland is performed with the following indications:

low effectiveness of drug treatment;
a large number of nodes;
adenoma;
suspicion of the possibility of converting a benign tumor into a malignant one (malignancy);
diffuse goiter;
planned pregnancy.

Preparing for the operation

Planned resection is carried out in the absence of exacerbated chronic diseases in the patient, the normal functioning of organs and systems. For 3-5 months, the patient is prescribed thyreostatics in order to reduce the manifestations of hyperthyroidism. Later, 10-14 days before the operation, the patient is prescribed iodine-containing drugs, which also suppress the production of hormones by the gland and beta-blockers. This preparatory therapy also reduces the level of blood flow to the gland, which helps to avoid excessive bleeding during surgery.

If it is necessary to conduct an urgent (urgent) operation, a course of glucocorticoids, iodine-containing drugs in higher doses and thyreostatics is carried out in order to prevent a thyrotoxic crisis.

Beta-blockers are prescribed both before surgery and in the postoperative period.

Incomplete resection of the thyroid gland has a number of risks. During the intervention, performing a resection of the thyroid lobe, the surgeon may accidentally remove the parathyroid gland or damage the recurrent nerve of the larynx. To minimize these complications, a method called the subtotal subfascial thyroid resection method according to O. V. Nikolaev has been used for half a century. The specificity of the operation is that the main technique is carried out inside the capsule of the gland, which minimizes the possibility of damaging the laryngeal nerves. Also, during the operation, the deep posterior layer of the thyroid parenchyma is not removed, behind which the paired parathyroid glands are most often located.

Stages

Before the immediate start of the operation, the surgeon conducts an ultrasound examination of the thyroid gland in order to determine the size and localization of the tumor, nodes, individual features of the anatomy of the neck area.

Then the location of the incision and the future suture are marked on the skin. Marking is preferably carried out with the patient awake, sitting or standing, since the suture is likely to be asymmetrical in the supine position.

The position of the patient on the back, a roller is placed under the shoulder blades so that the head is thrown back. General anesthesia is used.
The incision along the intended line is 1.0 - 1.5 cm higher from the jugular notch of the sternum between the sternocleidomastoid muscles. Depending on the volume of intervention, the length of the incision is on average 2-15 cm.
The skin, subcutaneous fatty tissue, broad muscle of the neck, superficial fascia in the form of a flap are dissected and pulled upward. Next, the 2nd and 3rd fasciae of the neck are cut longitudinally, the muscles are dissected or pushed apart, under which the gland is located in the connective tissue capsule.
Bandage and cross the vessels of the gland, along the way pushing the laryngeal nerve.
Separate the recurrent nerve from below to the place of its connection with the larynx.
The parathyroid glands are separated along with the thyroid layer, preserving blood flow.
Remove a portion of the gland. With subtotal removal, options for resection of one or both lobes are possible according to indications.
Remove nearby lymph nodes. This part of the operation is indicated in the presence of malignant tumors and their metastasis.
The tissues are sutured in reverse order, strictly in layers, drainage is left.

For suturing after removing the drainage, either non-absorbable material, or catgut, or special glue is used. With positive dynamics, the patient is not discharged for the third day.

Used drugs:

Thyroid resection - partial removal of the thyroid gland. Possible resection of the lobe of the thyroid gland, resection of both lobes of the thyroid gland, leaving a certain amount of tissue. At present, resections of the thyroid gland are rarely performed in specialized endocrine clinics, since with partial removal of the thyroid gland subsequently, scars appear in the operation area, and if a second operation is necessary (relapse, recurrence), technical difficulties arise, and the risk of complications increases.

When the patient received a consultation from an endocrinologist surgeon and surgical treatment is recommended, it is necessary to determine the date of the operation. It is important to note that there is no fundamental importance at what time of the year to perform the operation. There is an opinion that it is bad to "operate" in the summer months, but in fact, thyroid surgery can be performed at any time of the year. There is no special preparation for thyroid surgery, the main requirement is the absence of acute and exacerbation of chronic diseases in the body. Upon admission to the clinic, the patient undergoes tests (clinical blood test, biochemical, urinalysis, blood type, "coagulogram", chest x-ray and additional tests if necessary.). After receiving the results of the tests, the patient is examined by a therapist and an anesthesiologist (a doctor who produces). It is obligatory to have a conversation with the operating surgeon, who explains and answers all questions of interest to the patient. An obligatory step before the operation is to perform an ultrasound of the thyroid gland.

Carrying out the operation.

Operations on the thyroid gland are performed under general anesthesia (the patient is in drug sleep and does not feel pain). Patients often ask about the possibility of performing the operation under local anesthesia. It is important to understand that at present the level and quality of anesthesia are at a high level and from the point of view of safety for the patient, the operation "under anesthesia" is the best choice. The duration of the operation depends on the extent of the operation. On average, operations on the thyroid gland last from 60 to 100 minutes, although there are also long-term operations, with damage to the lymph nodes of the neck, lasting up to 3-4 hours.
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After the operation, the patient is usually transferred to the ward. On the first day after the operation, it is not recommended to get out of bed. If a drain (a thin silicone tube) was placed, it is removed the next day after the operation in the dressing room. While the patient is in the department, he is given daily dressings. The average stay in the clinic after surgery is 2-3 days. The patient is then discharged home. Before discharge, a mandatory conversation between the attending doctor and the patient, discussion of further treatment and follow-up periods.

Complications during operations on the thyroid gland.

Once again, I note that operations on the thyroid gland must be performed in a specialized surgical department of the endocrine profile with an endocrinologist surgeon. All complications in surgery can be divided into two main groups: non-specific (characteristic of any area of surgery) and specific (characteristic of a particular area in surgery). Non-specific complications include bleeding after surgery, which occurs in 1.5% of cases, suppuration of the postoperative wound from 0.3 to 0.8%, some patients may experience severe swelling of the neck. All of the listed non-specific complications are not common, and even if they occur, they respond well to treatment. Specific complications during operations on the thyroid gland include damage to the laryngeal recurrent nerves and hypoparathyroidism ("hypo" - little, "parathyroidism" - parathyroid hormones). There are two recurrent laryngeal nerves - right and left. They lie behind the thyroid gland and pass through the ligaments of the larynx to the vocal cords. The function of the recurrent nerves is to provide voice, the ability to speak. The risk of nerve damage in specialized clinics is less than 1%. In general surgical departments, the risk of damage is higher from 5 to 13%. After thyroid surgery, the patient may experience changes in the voice, but this is usually temporary. The risk of developing persistent hypoparathyroidism is about 1%.

Thyroid resection is an operation in which part of the thyroid gland is removed. It is possible to remove one or both lobes of the thyroid gland. At the same time, a small amount of tissue is left. In modern clinics today, resection of the thyroid gland is less and less common, since scars often form at the site of removal. And with repeated surgical intervention, technical difficulties arise, which leads to an increased risk of various complications.

Subtotal resection of the thyroid gland is an operation during which most of the thyroid gland is removed. At the same time, 4-6 grams of tissue is left from each lobe in place of the lateral surface of the trachea, recurrent nerves and parathyroid glands. The operation is performed under general anesthesia. After subtotal resection, replacement therapy with L-thyroxine is prescribed.

Surgical treatment of thyroid diseases is carried out if a person has the following pathologies:

adenoma;
nodular goiter, which leads to squeezing of surrounding tissues and can cause suffocation;
malignancy, which is difficult to confirm;
diffuse goiter: Graves' disease, Graves' disease;
there is a high probability of the tumor becoming malignant;
upcoming pregnancy;
nodular formations against the background of diffuse toxic goiter in men;
knots 3.5 cm or more in diameter;
an increase in the node by more than half a centimeter in half a year.

Subtotal resection of the thyroid gland has been used for more than half a century. It is considered the most effective way to treat thyrotoxicosis.

The operation is possible only if there is no exacerbation of chronic diseases, the patient is in a satisfactory condition and his weight is normal. Approximately 3-6 months before surgery, the sick person should receive thionamides. 7-10 days before resection, iodides are also prescribed, which is necessary to reduce the volume of blood supplied to the gland.

Another way to prepare for the operation is also possible - the appointment of a short course of beta-blockers in high doses, without thionamides. They normalize the work of the heart, without reducing catabolism. The use of the drug is recommended for mild thyrotoxicosis and if the patient does not tolerate thionamides.

Thyroid resection involves the following steps:

Ultrasound examination before the operation, which is performed by the operating surgeon (the location of the internal structure, the location of the tumor, the state of the lymph nodes is revealed).
Marking on the skin where the incision will be made.
General anesthesia.
Skin incision along the marking line. The size of the incision will depend on the type of disease and the size of the thyroid gland. The average length of the incision is 2-15 cm. With the complete removal of the thyroid gland and the lateral lymph nodes of the neck, the length of the incision will be maximum.
Secretion of the thyroid gland. For large tumors, it is performed with the intersection of the short muscles of the neck. Most often, the operation is performed without crossing the muscles, which ensures minimal pain after the operation, a decrease in swelling and allows the patient to quickly regain mobility.
Ligation and transection of the vessels of the thyroid gland, which is necessary to prevent injury to the external branch of the superior nerve of the larynx.
Isolation of the recurrent nerve. The gland is displaced towards the trachea, while the recurrent nerve is isolated from the lower part of the gland to the point of entry into the larynx.
Isolation and separation of the parathyroid gland. At the same time, the blood circulation of the gland is preserved.
Removal of part of the thyroid gland with suppression of the isthmus. The surgeon ligates and cuts off the blood vessels and then removes the lobe of the thyroid gland.
If necessary, remove the second lobe of the thyroid gland. The scheme is similar.
Lymph node dissection is the removal of lymph nodes and adjacent tissue. Remove if necessary. Increasingly, surgeons are resorting to central lymph node dissection. Lateral lymph node dissection is necessary if metastases are detected in certain areas.
Stitching of the neck muscles. For drainage at the operation site, a flexible silicone tube (Blake system) is brought in, which is connected to a vacuum suction. It is used to remove the rest of the blood. Blake's system allows you to reduce pain after surgery and make the process of drain removal less painful.
The imposition of cosmetic sutures. It is usually performed using a non-absorbable material when the suture is removed after the wound has healed. Or, absorbable material is used when suture removal is not required. It is possible to use special glue.

The consequences of resection of the thyroid gland can be early and late. The risk of recurrence is up to 20%, it all depends on the qualifications of the operating surgeon, the form and degree of the disease.

Early complications include the possibility of bleeding. Blood can get into the larynx, which will provoke asphyxia. With possible damage to the recurrent nerve, there may be a violation of voice formation, up to the complete disappearance of the voice.
Late complications include: hypoparathyroidism and hypothyroidism. The latter occurs when there is insufficient function of the remaining part of the thyroid gland. Hypoparathyroidism can develop if, in addition to the thyroid gland, the parathyroid glands are also removed. Sometimes a recurrence of diffuse toxic goiter may develop.

On average, after the operation, the patient stays in the hospital for 1 to 3 days. The most common complication after surgery is hoarseness, which is formed due to damage to the recurrent nerve. Postoperative bleeding is possible with an increase in blood pressure and diseases with impaired blood clotting.

Thyroid resection involves replacement therapy with Euthyrox or L-thyroxine. Depending on the risk of developing metastases, suppressive or replacement therapy with l-thyroxine is prescribed. Sometimes treatment is carried out with radioactive iodine.

After the operation, patients should be under the supervision of an endocrinologist or oncologist in a polyclinic at the place of residence. You should regularly undergo mandatory ultrasound control and check the level of hormones.

After the operation, the patient is prescribed synthetic and organic hormones. This is necessary to compensate for the production of various substances previously produced by the thyroid gland. It is very important to follow all the recommendations of the doctor and take the necessary medications. After surgery to remove the thyroid gland in the body, there is a violation of all body functions.

Thyrotoxicosis can be diagnosed as follows:

external examination of the patient, complaints;
a blood test for the level of thyroid-stimulating hormone (TSH), thyroid hormones (T3, T4);
Ultrasound (size of the organ, its individual parts, condition of the nodes);
biopsy of thyroid tissue.

Subtotal resection of the thyroid gland is performed with the following indications:

low effectiveness of drug treatment;
a large number of nodes;
adenoma;
suspicion of the possibility of converting a benign tumor into a malignant one (malignancy);
diffuse goiter;
planned pregnancy.

Beta-blockers are prescribed both before surgery and in the postoperative period.

Marking before the operation (vertical stripes indicate the edges of the seam and its middle, the incision is made only along a horizontal line).

The position of the patient on the back, a roller is placed under the shoulder blades so that the head is thrown back. General anesthesia is used.
The incision along the intended line is 1.0 - 1.5 cm higher from the jugular notch of the sternum between the sternocleidomastoid muscles. Depending on the volume of intervention, the length of the incision is on average 2-15 cm.
The skin, subcutaneous fatty tissue, broad muscle of the neck, superficial fascia in the form of a flap are dissected and pulled upward. Next, the 2nd and 3rd fasciae of the neck are cut longitudinally, the muscles are dissected or pushed apart, under which the gland is located in the connective tissue capsule.
Bandage and cross the vessels of the gland, along the way pushing the laryngeal nerve.
Separate the recurrent nerve from below to the place of its connection with the larynx.
The parathyroid glands are separated along with the thyroid layer, preserving blood flow.
Remove a portion of the gland. With subtotal removal, options for resection of one or both lobes are possible according to indications.
Remove nearby lymph nodes. This part of the operation is indicated in the presence of malignant tumors and their metastasis.
The tissues are sutured in reverse order, strictly in layers, drainage is left.

For suturing after removing the drainage, either non-absorbable material, or catgut, or special glue is used. With positive dynamics, the patient is not discharged for the third day.

Complications can be conditionally divided into two groups: early and late.

Early ones include:

profuse internal bleeding as a result of vascular injuries, blood if it enters the respiratory tract can lead to suffocation;
damage to the recurrent laryngeal nerve, as a result - hoarseness, aphonia;
air embolism in trauma to the veins of the neck.

hypothyroidism occurs when the remaining thyroid cannot produce enough hormones;
hypoparathyroidism when removing the parathyroid glands;
in 20% of cases there is a possibility of recurrence.

After the operation, a course of synthetic hormone replacement drugs is prescribed to compensate for the temporary lack of one's hormones and normalize the autonomic functions of the body. The patient is under regular supervision of an endocrinologist in order to timely identify all kinds of disorders.

How to prepare for the operation?
Operation
Complications

Thyroid resection is a surgical intervention during which the thyroid gland is partially removed. Both one and both parts of the thyroid gland can be cut out, but its tissues are partially left. Modern medicine uses thyroid resection less and less often, as scars often remain in the places of incisions. Not infrequently, certain difficult situations arise during repeated surgical intervention, which can subsequently lead to various complications.

Subtotal resection - what is it?

Extremely subtotal resection of the thyroid gland is a surgical intervention during which the main part of the thyroid gland is removed. During the operation, no more than 6 grams can be left. tissues from each part of the side of the trachea, recurrent nerve and parathyroid gland. The operation is performed using only general anesthesia, and upon completion, L-thyroxine replacement therapy is used.

A patient with thyroid diseases is prescribed surgical treatment only in the presence of certain pathologies, namely:

with adenoma;
at different stages of cancer;
during nodular goiter, which can lead to suffocation;
with malignant growths that are difficult to diagnose;
if the patient has Graves' disease and Graves' disease;
with the likelihood of growths in a malignant tumor;
when planning a pregnancy;
men with nodular formations against the background of diffuse toxic goiter;
when the nodes are more than 3.5 cm in size;
in the case when the nodes increase by more than 0.5 cm in 6 months.

Subtotal resection of the thyroid gland has been used in medicine for a very long time, and this method is considered the most effective in the fight against thyroid diseases.

How to prepare for the operation?

Before proceeding with subtotal resection, it is first necessary to prepare, but this should be done long before the intervention. 14 days before the subtotal subfascial resection of the thyroid gland, physicians prescribe therapy to reduce hyperthyroidism. During this period, the use of drugs containing iodine is recommended. There is a decrease in the blood supply to the thyroid gland - this is necessary in order to reduce the likelihood of hemorrhages and blood loss during the operation. In parallel, beta-blockers are prescribed.

Surgical intervention is performed only if the patient feels well, he does not have exacerbations in chronic diseases, and his weight is normal.

In the case when the patient needs to urgently undergo surgery, doctors prescribe glucocorticoid hormones in the form of injections. A cardiogram is made and the level of blood clotting is determined. Only after receiving all the necessary data, the surgeon, together with the anesthesiologist, sets the date and time when the operation will be performed. Doctors warn that 14 hours before surgery, the patient should stop eating and drinking.

Operation

As mentioned earlier, the operation is performed under general anesthesia. An incision is made no larger than 15 cm, which is located above the jugular notch of the sternum. Thus, there will be free access to the thyroid gland. The operation becomes problematic when the tumor covers the gland or if it is very large. Based on the results of the research, the subsequent course of the operation is determined. If the studies reveal positive dynamics of cancer cells, then in this case the glands are completely removed. If the postoperative period is positive, then the patient can be discharged after 3 days.

Complications

The postoperative period depends on the stage at which the operation was performed. The consequences of subtotal resection of the thyroid gland often cause complications that manifest themselves both in the early and late stages. It is worth considering that in 20% of cases there is a relapse of the disease, but this also depends on the degree of qualification of the specialist who performed the operation.

If we consider the early complications that arose after the operation, then they include:

suffocation from blood entering the larynx;
possible complete or partial disappearance of the head with a damaged nerve.

If we consider later manifestations after removal of the gland, then they include:

hypoparathyroidism - occurs when not only the thyroid gland, but also the parathyroid glands are removed during surgery;
hypothyroidism - if there is not enough thyroid gland for normal functioning.

In the postoperative period, the patient is prescribed sanitary and organic hormones in order to compensate for the lack of those substances that the glands produce.

Subtotal resection of the thyroid gland, considered the most effective treatment for thyrotoxicosis (a condition caused by elevated levels of thyroid hormones), has been performed for almost six decades.

Its implementation helps to significantly improve the quality of life of the operated patient.

Subtotal resection of the thyroid gland is called a surgical intervention, during which most of this organ is removed, but a small amount (from four to six grams) of its tissue is left on the lateral surfaces of the parathyroid glands, trachea and laryngeal nerve.

After performing this operation, substitution treatment with L-Thyroxine is necessary.

The operation of subtotal resection of the thyroid gland is indicated when:

different stages of cancer of this organ;
malignant growths of unclear etiology;
adenomas;
Hashimoto's disease - a chronic disease, most often diagnosed in women, in which the immune system produces antibodies to the cells of its own thyroid gland;
diffuse goiter (referred to as Graves' disease or Graves' disease);
nodular formations that occur in men against the background of diffuse toxic goiter;
high probability of malignancy of small benign tumors;
tumor nodes, the diameter of which exceeds 3.5 cm;
nodular goiter, leading to compression of adjacent tissues and fraught with the development of suffocation;
alarming dynamics, characterized by a high (more than 0.5 cm within six months) rate of increase in the tumor node.

Surgical treatment of thyroid pathologies is recommended for women planning pregnancy, as well as for patients who note the extremely low effectiveness of drug therapy.

The operation of subtotal resection of the thyroid gland requires a fairly long preoperative preparation.

At least three months before it, the attending physician prescribes thyreostatics to the patient- drugs that help reduce hyperthyroidism by inhibiting the production of thyroid hormones.
Two weeks before surgery, the patient begins to take beta-blockers and iodine-containing medications that suppress the ability of the thyroid gland to produce thyroid hormones. Another goal of drug preparatory therapy is to slightly reduce the blood supply to the thyroid gland. Thanks to this measure, it is possible to reduce the intensity of bleeding accompanying the operation and the likelihood of postoperative blood loss.
If there are indications for an urgent operation, the patient is prescribed iodine-containing drugs, thyreostatics and glucocorticosteroids in an increased dosage: this avoids the onset of a thyrotoxic crisis.
Appointment of beta-blockers shown both before and after surgery.

In the preoperative period, the patient must go through a number of standard laboratory tests:

Analysis of urine;
coagulogram;
blood test for the presence of antibodies to HIV, hepatitis, syphilis.

Among the laboratory tests, the following are of particular importance:

indicators characterizing the level of thyroid hormones in the blood;
results of pathomorphological diagnostics obtained by performing fine-needle puncture biopsy of tumor nodes.

The list of hardware research is quite impressive. The patient must undergo:

Ultrasound examination of the thyroid gland and cervical lymph nodes. With its help, it is possible to determine the location and size of nodes and tumor neoplasms, as well as the anatomical features of the zone of future surgical intervention.
Laryngoscopy is a diagnostic procedure that makes it possible to visually assess the condition of the vocal cords and larynx.
The procedure of computed tomography of the neck.
Radionuclide diagnostic study (scintigraphy), which allows visual assessment of the degree of hormonal activity of tumor foci and unchanged thyroid tissue.
Fluorography.

During the medical examination, the patient must visit the physician's office. After analyzing the data obtained in the course of the above studies, a team of specialists, consisting of the attending surgeon and an anesthesiologist, sets the date for the future operation.

The patient is then instructed to refrain from drinking any liquids and food fourteen hours before surgery.

Subtotal, subfascial resection of the thyroid gland according to Nikolaev

This type of surgical intervention, developed by the famous Soviet endocrinologist surgeon O. V. Nikolaev, is an operation that is almost not associated with the risk of damage to the parathyroid glands and recurrent laryngeal nerve.

The term “subtotal” in the name of the operation indicates that during its execution the surgeon removes the thyroid tissue almost completely, and the term “subfascial” indicates that the resection is carried out under the fascial capsule of this organ.

Sparing (in relation to the parathyroid glands and recurrent laryngeal nerve) nature of this surgical intervention is due to the topography of the thyroid gland. Since the parathyroid glands are located under the fascial capsule, and the recurrent laryngeal nerve is outside, surgical manipulations performed inside this capsule do not pose a threat to the aforementioned nerve.

The immunity of the parathyroid glands is carried out by maintaining a thin layer of tissue on the back surface of the thyroid gland.

Starting the operation, the surgeon makes a transverse arcuate incision located slightly above (no more than 1.5 cm) the jugular notch of the sternum. To gain access to the thyroid gland, he dissects the skin, subcutaneous tissue and superficial muscle of the neck (with the capture of the superficial fascia).

After pulling the resulting flap to the upper edge of the thyroid cartilage, the specialist performs a dissection of the second and third fascia of the neck, placing a longitudinal incision exactly in the middle: between the sternothyroid and sternohyoid muscles.

To expose the thyroid gland, the surgeon makes a transverse dissection of the sternohyoid muscle (sometimes the sternothyroid muscle has to be dissected in the same way).

To block the nerve plexus of the fascial capsule and facilitate the removal of the thyroid gland from it, a solution (0.25%) of novocaine is injected under the fascial capsule. The thyroid gland, removed from the capsule, is resected, and the bleeding is stopped with the help of special clamps.

After making sure of the reliability of hemostasis, they begin to stitch the edges of the fascial capsule by applying a continuous catgut suture. For suturing the sternohyoid muscle, catgut p-shaped sutures are used; for stitching the edges of the fascia - catgut interrupted sutures. Sewing of the skin edges is carried out using nodal synthetic or silk sutures.

The video shows the progress of subtotal resection of the thyroid gland:

Subtotal resection operations are also performed on the stomach. Resection of the stomach is a surgical intervention aimed at removing a significant part of it with the subsequent restoration of the continuity of the digestive tract.

Under the distal resection of the stomach is meant the removal of its lower part. The category of distal resections of the stomach includes:

an operation consisting in the removal of its antrum (located in the lower part of the stomach and engaged in grinding, mixing and pushing the food bolus through the sphincter);
subtotal resection, which consists in removing most of the stomach and leaving only a small area in the upper part of the digestive organ.

With proximal resection of the stomach, the entire upper part of it is removed along with the cardiac sphincter that separates the stomach and esophagus; the lower part of the digestive organ (to one degree or another) is preserved.

In the presence of a small exophytic malignant neoplasm localized in the lower third of the stomach, a subtotal resection of the stomach can be performed using one of the methods proposed by the German surgeon Theodor Billroth:

The first option for restoring gastrointestinal continuity, called Billroth I, begins with the removal of two-thirds of the stomach. After that, partial suturing of his central stump is performed. The dimensions of the lumen to be left should correspond to the diameter of the duodenum, since at the next stage of the operation an anastomosis is formed between the duodenum and the stomach stump using the end-to-end method. After resection performed in this way, the possibility of anatomical and physiological advancement of the food bolus along with bile remains. The main advantage of operations of this type is the speed of execution and their technical simplicity. This technique has two drawbacks: the presence of a junction of three sutures at once and the likelihood of tissue tension in the upper part of the anastomosis. Each of these shortcomings can provoke suture eruption, making the anastomosis untenable. This complication can be avoided by impeccably mastering the technique of performing the operation.
The second version of this technique (Billroth II) involves the formation of a wide gastroenteroanastomosis between the beginning of the jejunum and the stump of the stomach, imposed by the "side to side" method. This method is resorted to if it is not possible to form an anastomosis by the above method.

On the video, laparoscopic distal subtotal resection of the stomach:

The operation of subtotal resection of the thyroid gland is fraught with the development of a number of complications associated with risk:

profuse internal bleeding (in case of damage to blood vessels), dangerous for the development of suffocation when blood enters the respiratory tract;
air embolism resulting from damage to the jugular veins;
purulent-septic (the greatest danger is neck phlegmon) complications;
accidental removal of the parathyroid glands, which is fraught with the development of metabolic disorders (the most striking of them is hypoparathyroidism - a disease caused by a lack of parathyroid hormone);
serious damage to the recurrent laryngeal nerve, which is responsible for the innervation of the vocal apparatus and can cause aphonia (loss of voice sonority) and hoarseness;
paralysis of the vocal cords that occurs with bilateral trauma to the laryngeal nerve;
airway obstruction;
development of postoperative thyrotoxicosis, the main manifestations of which are: severe tachycardia, hand tremor, anxiety, severe fatigue. This condition may develop due to improper selection of hormonal treatment;
probable (in every fifth case) recurrence.

The main advantage of subtotal resection of the thyroid gland is the fact that lifelong hormone replacement treatment is not required after it, since due to the preservation of part of the glandular tissue, it is possible to continue producing hormones, and in sufficient quantities for the body.

In addition, after the operation:

There is no need for frequent and expensive hormone tests.
The patient gets rid of a debilitating condition characterized by frequent changes from hypothyroidism to hyperthyroidism.
Freed from the need to take toxic antithyroid drugs, women can carry and give birth to children.

After subtotal resection of the thyroid gland, the patient is prescribed synthetic hormone-replacing drugs (the most popular are euthyrox and L-Thyroxine), designed to compensate for the temporary shortage of their own thyroid hormones and normalize the course of vegetative processes.

In order to timely identify and prevent the occurrence of all kinds of pathologies, the patient must regularly (at least twice a year) visit his treating endocrinologist. Its condition is monitored by:

undergoing an ultrasound examination;
performing scintigraphy;
taking a blood test for hormones.

If there are indications, the endocrinologist will correct the daily dosage of hormonal drugs.