Best Surgeons performing Subtotal Thyroidectomy Surgery in India-video

Subtotal Thyroidectomy surgery in India is done by the best surgeons of the country hence, attracting a large number of foreign patients. With rapidly expanding infrastructure, clinical expertise and international standard implementation, the Indian hospitals are servicing the healthcare needs of international patients from around the world. People prefer subtotal thyroidectomy surgery in India because of the availability of clinical expertise and internationally trained and educated medical professionals. Subtotal thyroidectomy is the procedure performed to remove a lobe, the isthmus, or a part of the other lobe of the thyroid gland. Located in the front of the neck, the thyroid is a butterfly-shaped gland, consisting of two lobes connected by an isthmus. The gland is responsible for regulating metabolism by secreting hormones. Thyroid problems can often be treated medically, but in some cases, the thyroid needs to be removed. The extent of thyroid removal depends on the patient’s condition. When diseases like thyroid cancer, goiter and hyperthyroidism affect the thyroid subtotal thyroidectomy needs to be performed.

Symptoms

• A lump in the front of the neck.
• Difficulty of swallowing because of the lump.
• The nodules create an excessive amount of thyroid hormone
• Heat intolerance
• Palpitations, fast heart beat etc

Causes of subtotal thyroidectomy -

• Heredity
• Age
• Nodules are more likely to form in people who have chronic inflammation of the thyroid gland.
• Radiation exposure to the head or neck
• Exposure to nuclear power plant accidents, or radioactive particles

Procedure – During the subtotal thyroidectomy patient is placed supine (face up) on the operating room table. A folded towel is placed under the neck to hyperextend the neck. The top part of the table is elevated so the patient is in a slightly reclining position. The head of the patient must be perfectly aligned with the body so a symmetrical incision is made by the surgeon.

Bleeding vessels in the skin and subcutaneous tissue are controlled by applying hemostats and ligated using 3-0 or 4-0 absorbable sutures. Incision is carried through the rather superficial platysma muscle to the avascular plane below this muscle. Tissue flaps are raised both superiorly and inferiorly using a combination of blunt and bovie cautery dissection. The superior dissection is taken up to the level of the thyroid cartilage and the inferior dissection is taken to the level of the sternal notch. The large vein usually found under both flaps is ligated with silk suture and incised with a Metzenbaum scissors. The left and right anterior jugular veins are usually ligated with double silk ties and incised with a scissors.

A self-retaining retractor is then placed to hold the two edges of the skin flaps apart to allow adequate exposure of the underlying strap muscles. The sternohyoid muscle is lifted up on either side of the midlline and an incision is made in the exact midline of the sternohyoid muscle. Alternately, the sternohyoid muscle can be incised transversely with bovie cautery and retracted inferiorly and superiorly. Blunt dissection is used to develop the plane underneath the sternohyoid muscle. This will expose the sternothyroid muscle. The sternothyroid muscle is incised after the loose areolar tissue is grasped and retracted toward the ceiling. It is important to enter the correct plane between this muscle and the thryoid. This exposes the capsule of the thyroid and the anterior capsular veins of the thyroid. The thyroid gland is then partially delivered up into the wound by placing two fingers and the lateral edge of the gland and slightly separating them. Many subtotal thyroidectomy surgeons ligate and divide the right middle thyroid vein at this time.

The dissection of the thyroid gland is usually done by freeing the right upper pole first. Dissection is done either by gentle blunt force by inserting a finger or hemostat under the right superior thyroid vessels. The vessels are ligated with silk ties or very commonly with a Harmonic scalpel. It is important that all vessels be carefully ligated as it is difficult to control cut vessels that have not been ligated as they tend to retract to a position very near the superior laryngeal nerve. The superior thyroid artery should be ligated outside of and away from the gland. After the right superior thyroid vessels and the right middle thyroid vein have been controlled, attention is turned to the right lower pole of the thyroid. The inferior pole arteries and veins are carefully ligated with care taken not to disrupt the adjacent parathyroid gland or to injure the underlying trachea. If a thyroidea is present, it is carefully separated from the trachea and ligated and divided.

The inferior thyroid artery is then located on the inferior lateral part of the gland by retracting the thryoid medially and superiorly. This artery is ligated. Great care must be taken to completely separate it from the right recurrent laryngeal nerve that is always found adjacent to the artery (it may even run between the bifurcation (branches) of the artery). The right side of the gland is then dissected off of the trachea using find tipped forceps to guide the Bovie cautery and a small sponge to push the thryoid medially. When the midline of the trachea has been reached, clamps are placed on each side to compress the thyroid tissue. The isthmus is then divided between the two rows of clamps using Bovie cautery. The right thyroid specimen is then removed from the operating theater. The subtotal thyroidectomy surgeon then moves to the patient’s left side and removes the left side of the thyroid gland using the same steps as described above.

After the gland has been removed, the folded sheet behind the patient’s neck is removed and the hyperextension of the neck is released. The wound is irrigated and the field is repeatedly checked for any bleeding points. Meticulous hemostasis is critical in thyroid surgery to prevent a clot from forming and compressing the trachea. Many surgeons will leave a small suction-type drain in the thyroid cavity, even in the presence of a dry field. This is brought out through a stab wound the skin laterally on the neck. The strap muscles are then re approximated and if transected closed using absorbable are interrupted suture. At the end of the subtotal thyroidectomy the skin is closed using a subcuticular aborbable stitch or interrupted using 4-0 or 5-0 nylon sutures.

Risks associated with the surgery

• Internal bleeding
• Infection
• Blood could form and lodge in the lungs, making it difficult to breath. Without the surgery, you risk, spreading cancer, or.

Advantages of subtotal thyroidectomy surgery

• The patient can decrease the chances of thyroid storm.
• The patient can decrease the chances of spreading cancer.
• The patient can decrease the chances of asphyxiation by the swollen gland

Medical tourists coming to India for subtotal thyroidectomy surgery can greatly benefit by the quick medical appointments for the surgery and comfortable medical rehabilitation post the surgery. Subtotal thyroidectomy surgery in India is available at various hospitals of Mumbai, Bangalore, Hyderabad, Chennai and New Delhi. These hospitals have the highly skilled, certified surgeons and a great support staff.

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