1
Q
Thyroidectomy (total)
A
- Total removal of all of the thyroid gland (tissue)
2
Q
Thyroid Lobectomy
A
- removal of one lobe and possibly the isthmus of the thyroid
3
Q
Bilateral Subtotal Thyroidectomy
A
- near total removal of both lobes leaving small remnants of the thyroid gland and parathyroids
4
Q
Parathyroidectomy
A
- Removal of one or more of the 4 parathyroid glands.
5
Q
Hernia
A
- An abnormal protrusion of an organ or tissue through a defect or weakness in the tissue normally containing it.
6
Q
Herniorrhaphy
A
- Repair of a musculofascial defect, through which various organs or tissues may present
7
Q
Inguinal Herniorrhaphy (open/laparoscopic)
A
- repair of the musculofascial defect in the groin, the herniated tissues presenting through the abdominal wall medial to the deep inferior epigastric vessels (direct); or through the deep inguinal ring and inguinal canal, emerging at the superficial inguinal ring (indirect)
8
Q
Umbilical Herniorrhaphy (open/laparoscopic)
A
- Repair of musculofacial defect within the umbilicus (or about the umbilicus) most often seen in children, pregnant women , or obese adults
9
Q
Incisional (Ventral) Herniorrhaphy
A
- repair of a defect underlying the scar of a previous surgical site in the abdomen through which viscera or fat may protrude
10
Q
Breast biopsy can be either:
A
- Excisional– want to take the entire mass + margin around it
- Incisional–get just a little peice of the mass
11
Q
Needle/Wire Localization
breast biopsy
A
- For a lesion previously detected by mammogram and too small to “palpate”, it may be localized by the insertion of a needle or a wire by a radiologist, pre-operatively. (not done in OR!) The needle/wire is placed within the suspect area, and the distal end is left outside the skin. The pt is then sent to the OR for surgical biopsy. The excised tissue (with the needle/wire still in place) is sent directly to radiology for verification of suspect lesion, and then on to pathology
12
Q
Sentinel Node Biopsy (SNB)
A
- The sentinel node is the first lymph node along the lymphatic channel from the primary tumor site. These nodes are not located in the same site for every pt.
- breast mass is injected with radio-isotope in the radiology dept. several hours before the scheduled biopsy in the OR.
- Once in the OR, the tumor is injected with a dye containing Isosulfan blue that is taken up by the lymph nodes of the breast
- another technique is to inject Technetium (a gamma-emitting material) in radiology. Once in the OR a sterile (put bag over) Geiger counter probe is used in the sterile field to locate areas of radioactivity.
- With either method, the nodes are then excised and sent to pathology for frozen section
13
Q
Lumpectomy
A
- A procedure to remove a “lump” of breast tissue. This lump may be a small malignant mass, fibrocystic tissue, cyst, or benign breast nodule (fibroadenoma). It may also be referred to as a “segmental resection or a wide local excision”. It tends to be a more conservative approach to breast cancer treatment.
14
Q
- Simple Mastectomy:
- Modified Radical Mastectomy (MRM):
- Radical Mastectomy:
A
- Removal of just breast tissue, no nodes
- (done frequently) Removal of all breast tissue, nipple, areola, peel breast tissue off of pectoralis major muscle with axillary node dissection
- (Performed very rarely these days) Removal of nipple, areola, all breast tissue + pectoralis major muscle and axillary node dissection
15
Q
Axillary Node Dissection
A
- Removal of the axillary nodes through an incision in the axilla.
- usually done through a seperate incision from any other breast procedure that may be performed
- removal and examination of the axillary nodes allow for staging the cancer and aiding in the surgeon’s choice of further treatment
- not always associated w/ breast cancer
16
Q
A
Lahey Thyroid Traction Forceps
17
Q
A
Green Thyroid Retractor
18
Q
A
Crile thyroid retractor
19
Q
A
Lahey Thyroid Retractor
20
Q
Thyroid
A
- The thyroid gland is grouped with the endocrine system
- Follicular cells produce thyroid hormones
- The function of the thyroid therefore is to regulate the body’s metabolism
- All endocrine glands have one thing in common–don’t have ducts. discharge hormones directly into bloodstream
21
Q
Hormone
A
- chemical messengers carried throughout body only to certanin organs or types of cells that respond to their stimulus. (Target cells)
- necessary for growth and brain development
22
Q
ANATOMY of the thyroid
A
- The thyroid gland is located in the neck, located below the thyroid cartilage
- has upper and lower lobes
23
Q
Cross Section of the Thyroid
A
- The thyroid gland is enclosed in a thin layer of pretracheal or visceral fascia, which also includes the trachea and esophagus
24
Q
Platysma muscles
A
- Most of the anterolateral surface of the neck is covered by the thin platysma muscles.
- thin, superficial
25
After retraction of the platysma muscles you see
* Sternocleidomastoid muscles cover the internal jugulars and carotid sheaths.
26
deep to the Sternocleidomastoid muscles are
* Thyroid is covered by strap muscles
* Sternohyoid (Strap)
* Sternothyroid (Strap)
* omohyoid muscles.
27
Arterial blood supply
* Superior thyroid artery supplied by the external carotid artery.
* Inferior thyroid artery -- is supplied by the thyrocervical trunk of the subclavian artery.
28
Venous Drainage
* Superior thyroid vein
* Middle thyroid vein
* Inferior thyroid vein
29
Nerve Supply - Thyroid
* Superior laryngeal nerve: on each side of the thyroid; lies in close proximity to the sup. thyroid artery.
* **Recurrent Laryngeal Nerve: Supplies the vocal cords & is in close association with the inferior thyroid artery. Very important, can't damage this, be carful when retracting, may use a nerve stimulator**
* Inferior Laryngeal Nerve (branch of recurrent Laryngeal)
30
Recurrent Laryngeal Nerve
* supplies vocal cords
* recurrs by looping
31
Hormones of the Thyroid
* T4 = Thyroxine
* T3 = Triiodothyronine
* T4 must be converted to T3 before being used by body
* iodine in foods helps with synthesis of T3 & T4
* Calcitonin
* helps in metabolism of calcium
* heart muscles to move
* bones strong
* electric response of heart
32
Feedback system
* Hypothalamus
* Thyrotropin-releasing hormone (TRH)
* Pituitary
* Thryoid-Stimulating Hormone (TSH)
* Thyroid
* T3 & T4
33
Parathyroids
* Small brownish-red (look like lentils)
* Work independently of thyroid gland
* Four (4) total
* 2 superior with one on each side
* 2 inferior with one on each side
* **Save these during surgery! They are implanted back into the muscle of pt.**
34
Parathyroids Secrete...
* Secrete Parathyroid Hormone (PTH)
* Antagonist to calcitonin (brings calcium up)
35
Thyroid Conditions
* Goiters- enlargement of thyroid gland
* Thyroid Cancer-
* Thyroid Nodules
* Hyperthyroidism
* Hypothyroidism
* Thyroiditis
* Cretinism- baby no growth
* Graves- young women autoimmune
* Thyroid storm- levels of TSH are low
36
Diagnostic testing for Thyroid:
* T3 and T4
* TSH assays
* Thyroid Isotope Scan
* Ultrasonic scans
* Fine Needle Aspiration (FNA)
37
Four (4) Thyroid Surgeries
* Thyroid Lobectomy
* Bilateral Subtotal Thyroidectomy
* Near Total Thyroidectomy
* Total Thyroidectomy
Why surgery?
* treat cancer
* determine if a nodule is benign or malignant
* releive pressure form goiter
* control hyperthyroidism
38
Thyroid Lobectomy
* removal of one lobe and possibly the isthmus of the thyroid.
39
Bilateral Subtotal Thyroidectomy
* near total removal of both lobes leaving small remnants of the thyroid gland and parathyroids
40
Near Total Thyroidectomy
* complete removal of one lobe of the thyroid with almost complete removal of the other lobe
41
Total Thyroidectomy
* total removal of all thyroid tissue
42
Supplies for Thyroidectomy
* Head & Neck Pack
* Minor set & Thyroid set or Breast set
* Basin set
* Bovie & Bipolar forceps
* Mahorner or Weitlaner Retractor
* Green Retractors
* Kittners/ Peanuts -always put on kelly or Peon
* Small Rt. Angles
* Delicate hemostats (mosquitoes)
* Tracheostomy set and tubes (available)
* 10cc syringe for balloon
* KB #10 & #15
* Suture - 3-0 & 4-0 silk ties Baby hemoclips
* 1/4" penrose
43
Which ties would work best on a thyroid lobectomy?
B.
44
Which suture is the best choice to reapproximate the strap muscles?
C. dainty needle
45
Which suture is the best choice for a subcuticular closure?
A.
46
Mahorner Retractor
47
Lone star retractor and hooks
48
Where does most glandular breast cancer come from?
* upper lateral neat tail of spence
49
Breast Cancer Signs and symptoms
* Lump or mass in the breast, breast pain
* Change in symmetry or size of breast
* Change in skin- thickening, scaly skin around nipple, dimpling, edema (peau d' orange), or ulceration
* Change in skin temperature (a warm, hot, or pink area)
* Unusual drainage or discharge
* change in nipple (itching, burning, erosion, or retraction)
* Pathologic bone fractures, hypercalcemia
* Edema of the arm
50
Thyroid Storm
* a rare but often life-threatening medical emergency resulting from untreated hyperthyroidism.
* marked by fevers, sweating, restlessness, irritability, tachycardia, hypertension, heart failure, shock, cardiac arrhythmias
* Treatment: antithyroid meds, beta blockers, steroids, iodine
Surgical Procedures I
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