Hello, this is Jeremy Richmon from Johns Hopkins hospital. On behalf of Jason Prescott and myself, I’ll be presenting a case of Robotic Thyroidectomy through the face lift approach. Here we have a young woman with a four centimeter right thyroid nodule. She has a long, slender neck with no visible skin creases. She is very motivated to avoid a visible and potentially disfiguring skin incision in her neck. This, as well as a history of keloiding and hypertrophic scarring are some of the indications for this procedure. Here the patient is positioned on the operative.
Table with her head turned towards the left. About one centimeter of her hair has been shaved and the incision is marked behind the hair line so that when this area grows back in this area will be invisible. There we see the relation of the incision to the thyroid nodule itself. After the skin flap has been raised retracters are placed to elevate the skin and strap muscles and pull back the sternoclatomastoid muscle to gain access to the thyroid gland. With the retractors in place, one can appreciate the great view of the right thyroid lobe.
Here the robot is docked prior to the robotic portion of the procedure. This is now the view through the robotic console. And Maryland forceps and harmonic instrument are used to perform the dissection. MUSIC Some of the strap muscles divided here in order to facilitate access to the superior pole of the thyroid lobe. MUSIC The tutorial has been sped up here to demonstrate how the superior pole of the thyroid gland is taken down. MUSIC Here the position of the trachea is confirmed. And its UNKNOWN is divided with the harmonic.
Robotic Thyroidectomy Facelift Approach Dr. Jeremy Richmon
Here we can clearly appreciate the right parathyroid gland, demarketed in blue. As we’re coming across the lateral surface of the thyroid lobe. Also appearing is the bounding right inferior thyroid artery, both of these landmarks help localize the position of other recurrent laryngeal nerve, with the nerve stimulating probe. MUSIC Here we see the right recurrent laryngeal nerve crossing on top of the artery. It is stimulated for confirmation. MUSIC The UNKNOWN is used to gently dissect out the recurrent laryngeal nerve and parathyroid gland from the thyroid, again, in fast motion.
MUSIC With the nerve and parathyroid gland safely dissected free, attention is turned to dissecting the rest of the thyroid gland off the trachea. MUSIC Now the last few attachments are released and the entire right thyroid lobe is removed. MUSIC The wound is closely evaluated to confirm hemostasis. And the relationship between the inferior thyroid artery and the recururent UNKNOWN nerve and the parathyroid gland can be appreciated. The nerve is stimulated one final time to confirm integrity. Here we have the removed right thyroid lobe. And the immediate postoperative appearance of the patient.