Endocrine

Question 1

Partial Thyroidectomy steps

Answer 1

1. Transverse incision, elevate subplatysmal flaps
2. Take upper pole vessels first
3. Mobilize lobe anteriorly and medially, staying close to thyroid gland
4. identify parathyroids and preserve blood supply

Question 2

Total Thyroidectomy Steps

Answer 2

1. Collar incision, raise subplatysmal flaps, separate strap muscles
2. separate lateral boder of thyroid gland from strap muscles and carotid sheath, divide upper pole vessels
3. rotate thyroid anteriorly, identify recurrent laryngeal nere in tracheoesophageal groove
4. Divide ligament of berry anterior to passage of nerve into the larynx
5. Separate thyroid off trachea
6. identify and inspect parathyroid glands, reimplant if necessary

Question 3

Central neck dissection steps:

Answer 3

1. Dissect out recurrent laryngeal nerves, and remove all fibroadipose tissue between carotid sheaths laterally, hyoid bone superiorly, barchiocephalic vessels inferiorly

Question 4

Laparoscopic Left Adrenalectomy Steps:

Answer 4

1. Lateral decubitus position, laparoscopic entry
2. Mobilize splenic flexure of colon, divide peritoneal attachments of spleen and lienophrenic ligament
3. Reflex spleen medially, mobilize pancreatic tail
4. Divide inferior phrenic vessels, and central adrenal vein
5. Divide inferior and lateral attachments