Aira Hospital

Surgery of the large, sometimes huge, colloid goiters demands a somewhat different technique. Many surgeons recommend preoperative treatment with Lugol’s solution to reduce the vascularity of the goiter and diminish bleeding peroperatively. I personally do not believe it makes any difference, and until now I haven’t seen any conclusive research that supports the idea.

 

The skin and platysma is dissected sharp with a knife as one layer.

 

With large goiters I always cut and part the pretracheal muscles between straight clamps which are then hold in Babcock’s forceps.

 

Using exclusively manual dissection I first ligate and cut the lower pole vessels near to the gland (to avoid the parathyroid gland),

 

then the upper pole vessels are isolated, clamped, cut and ligated

 

and finally the medial thyroid vein.

 

The gland can then be mobilized medially and the medial thyroid artery is ligated in situ.

 

The Isthmus is isolated – again with finger dissection - clamped and cut.

 

After that the lobe is easily resected

 

The margins of the lobe are sutured together with a continuous heavy absorbable suture.

 

The same procedure is executed on the contra-lateral lobe.

 

I always identify the recurrent nerves and watch out for the parathyroid glands. However I do not specifically dissect to find and identify the parathyroid glands, but try the outermost to preserve them when I come into contact with them. 

Since lifelong substitution with thyroxin is not possible to implement in this area, it is important to leave enough glandular tissue to secure a sufficient production of thyroid hormone.

 

The pretracheal muscles are sutured with a continuous absorbable suture before closure of the skin. It is prudent to leave two small bore tube drains for 24 hours.

 

Careful and continuous observation postoperatively is essential

 

Usually the patient recovers fast and can be discharged the following day.

The surgical fee for this procedure is 400 birr (27 €). With bed and everything included the total cost is around 500 birr (35 €).