caa a22 4500 47580306X CHVBK 20180406123743.0 cr unu---uuuuu 170329e20000801xx s 000 0 eng 10.1007/s002680010173 doi (NATIONALLICENCE)springer-10.1007/s002680010173 Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of Technique [Elektronische Daten] [Richard D. Bliss, Paul G. Gauger, Leigh W. Delbridge] The cornerstone of safe and effective thyroid surgery is thorough training in and understanding of thyroid anatomy and pathology. With appropriate techniques, total thyroid lobectomy and total thyroidectomy (which should be considered simply as a bilateral total thyroid lobectomy performed during the same operation) can be undertaken with minimal risk of damage to the recurrent laryngeal nerves, the external branches of the superior laryngeal nerves, and the parathyroid glands. Safe surgery requires a specific operative plan, progressing in a series of logical, orderly, anatomically based steps. Exposure of the thyroid gland is followed by careful dissection of the superior pole, utilizing the avascular plane between the superior pole and the cricothyroid muscle to identify and preserve the external branch of the superior laryngeal nerve. Medial retraction of the gland then allows dissection of the lateral aspect of the thyroid lobe. Protection of the recurrent laryngeal nerves and preservation of the blood supply to the parathyroid glands is best achieved by "capsular dissection,” ligating the tertiary branches of the inferior thyroid artery on the gland surface. If a parathyroid gland cannot be preserved or becomes ischemic after dissection of its vascular pedicle, it should be immediately minced and autotransplanted into the ipsilateral sternocleidomastoid muscle. The current evolution of outpatient or short-stay thyroidectomy emphasizes the need to avoid complications by utilizing meticulous surgical technique. Minimally invasive thyroidectomy utilizing endoscopic techniques may also affect the practice of thyroid surgery. Even so, understanding the surgical anatomy of the thyroid gland and its possible variations is paramount to safe and effective surgery. Société Internationale de Chirurgie, 2000 Bliss Richard D. Department of Surgery, Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales 2065, Australia, AU aut Gauger Paul G. Department of Surgery, Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales 2065, Australia, AU aut Delbridge Leigh W. Department of Surgery, Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales 2065, Australia, AU aut World Journal of Surgery Springer-Verlag 24/8(2000-08-01), 891-897 0364-2313 24:8<891 2000 24 268 https://doi.org/10.1007/s002680010173 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002680010173 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bliss Richard D. Department of Surgery, Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales 2065, Australia, AU aut NATIONALLICENCE 700 1- Gauger Paul G. Department of Surgery, Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales 2065, Australia, AU aut NATIONALLICENCE 700 1- Delbridge Leigh W. Department of Surgery, Endocrine Surgical Unit, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales 2065, Australia, AU aut NATIONALLICENCE 773 0- World Journal of Surgery Springer-Verlag 24/8(2000-08-01), 891-897 0364-2313 24:8<891 2000 24 268 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer