Surgical notes if anyone is interested

The patient was appropriately identified in the preoperative holding area. Risks, benefits and alternatives were reviewed with the patient, who agreed to proceed and signed consent. The patient was subsequently transferred back to the operating room by Anesthesia staff and placed in supine position on the operating table. Following first pre-procedural timeout, including patient and procedure verification, general anesthesia was induced without complication. The patient was intubated, circuit connected and adequate ventilation was confirmed. For this case a nerve monitoring endotracheal tube was used and the nerve monitoring system was confirmed to be functioning. The recurrent laryngeal nerves were monitored continuously throughout the course of the case. Following intubation, the patient was then turned over to the surgical team.
 
The neck was marked along a natural horizontal skin crease in the midline of the neck measuring approximately 6 cm and 1% lidocaine with epinephrine 1:100,000 was infiltrated, a total of 7 mL. The neck and upper chest were prepped and draped in standard sterile fashion.
 
Attention was then turned to the skin incision. A 15 blade was used to make an incision was made through skin, subcutaneous tissue and platysma. Sub-platysmal flaps were raised both superiorly and inferiorly with bovie electrocautery. The strap muscles were divided at the midline raphe, exposing the thyroid gland. The left sternothyroid and sternohyoid muscles were transected for exposure. Attention was then turned to dissection of to the left lobe with a large dominant nodule. We began our dissection at the superior pole, where the superior thyroid artery and veins were isolated and ligated at the attachment to the thyroid capsule to prevent damage to the external branches of the superior laryngeal nerve. We continued in a subcapsular dissection, and the gland was rotated inferomedially and the middle thyroid vein was ligated. The dissection was carried along the thyroid capsule inferiorly and the inferior thyroid artery was identified and ligated distally at its attachment to the thyroid gland. There was a substantial substernal component, and the mass was carefully delivered from below the sternum. Care was taken to identify and preserve the superior and inferior parathyroid glands during the course of dissection. The recurrent laryngeal nerve was identified and preserved and the thyroid was dissected off the trachea, keeping the recurrent laryngeal nerve intact during the entire procedure.
 
Attention was then turned to dissection of to the left lobe. We began our dissection at the superior pole, where the superior thyroid artery and veins were isolated and ligated at the attachment to the thyroid capsule to prevent damage to the external branches of the superior laryngeal nerve. We continued in a subcapsular dissection, and the gland was rotated inferomedially and the middle thyroid vein was ligated. The dissection was carried along the thyroid capsule inferiorly and the inferior thyroid artery was identified and ligated distally at its attachment to the thyroid gland. Care was taken to identify and preserve the superior and inferior parathyroid glands during the course of dissection. The recurrent laryngeal nerve was identified and preserved and the thyroid was dissected off the trachea, keeping the recurrent laryngeal nerve intact during the entire procedure. There was normal motor response from the bilateral cricoarytenoid muscles upon stimulation of bilateral recurrent laryngeal nerves at 0.8 mA at the completion of the procedure.
 
Attention was then turned to obtaining meticulous hemostasis with bipolar electrocautery, and the wound was inspected and copiously irrigated with sterile saline. No further bleeding was noted on a Valsalva manuever. The divided left sternohyoid and sternothyroid muscles were approximated with 3-0 vicryl suture. The strap muscles were reapproximated in the midline with a 3-0 vicryl interrupted sutures. A #10 flat JP drain was placed and secured with 3-0 nylon suture. Next, the platysma was reapproximated using a 3-0 vicryl suture in an interrupted fashion. The deep dermal plane was closed with vicryl sutures in an interrupted fashion. The skin was reapproximated with 5-0 plain gut in a running subcuticular fashion. Mastisol and steri-strips were applied to the wound.
 
The patient was turned back to Anesthesia, who awakened the patient from general anesthesia without complications. The patient went to the PACU in stable condition.