Cai Zhentong (Department of Surgery, Shunyi County Hospital, Beijing)
We made some improvements in the thyroid operation under acupuncture anaesthesia in recent years in order to shorten the time of operation, to lessen bleeding and to minimize pain. The important improvements are summarized as follows.
1. Body position. The patient is laid without hyperextension of his neck to avoid undue stress.
2. Incision. Skin incision is made swiftly with a sharp knife to minimize pain.
3. Mobilizing and hanging skin flaps. The skin flaps are mobilized by sharp dissection along the cleavage of superficial cervical fascia just beneath the platysma. The dissection is made upward to the level of the thyroid cartilage and downward to the sternum. The skin flaps are then hung up and fixed to the nearby sterilized sheet by sutures, so as to prevent the painful sensation caused by instrument retraction.
4. Transsection of muscles. The infrahyoid muscles must be transsected in cases of large glands or glands with high upper poles. The bilateral sternomastoid muscles should be mobilized from the infrahyoid muscles before the transsection. The transsection line should be high enough and slightly curved upward at the level of the upper pole.
5. Mobilization and excision of gland. The connective tissue surrounding the gland is dissected gently and sharply in order to alleviate the painful sensation. For glands with high upper poles, the lower pole may be mobilized first. For glands with wide and thick isthmus, both lobes may be resected simultaneously in order to save time and prevent unnecessary bleeding.
6. Treatment of residual gland. Ligation of the vessels at the level of excision should be carried out prior to the resection of the thyroid gland. Suitable pressure should be applied on the posterior portion of the thyroid gland with finger tips to lessen bleeding. The wound surface is sutured interruptedly with 000 fine silk.
7. Close of incision. 000 fine silk is used for suturing the platysma and skin separately. Small and sharp cutting needle should be used to suture the skin.
We made some improvements in the thyroid operation under acupuncture anaesthesia in recent years in order to shorten the time of operation, to lessen bleeding and to minimize pain. The important improvements are summarized as follows.
1. Body position. The patient is laid without hyperextension of his neck to avoid undue stress.
2. Incision. Skin incision is made swiftly with a sharp knife to minimize pain.
3. Mobilizing and hanging skin flaps. The skin flaps are mobilized by sharp dissection along the cleavage of superficial cervical fascia just beneath the platysma. The dissection is made upward to the level of the thyroid cartilage and downward to the sternum. The skin flaps are then hung up and fixed to the nearby sterilized sheet by sutures, so as to prevent the painful sensation caused by instrument retraction.
4. Transsection of muscles. The infrahyoid muscles must be transsected in cases of large glands or glands with high upper poles. The bilateral sternomastoid muscles should be mobilized from the infrahyoid muscles before the transsection. The transsection line should be high enough and slightly curved upward at the level of the upper pole.
5. Mobilization and excision of gland. The connective tissue surrounding the gland is dissected gently and sharply in order to alleviate the painful sensation. For glands with high upper poles, the lower pole may be mobilized first. For glands with wide and thick isthmus, both lobes may be resected simultaneously in order to save time and prevent unnecessary bleeding.
6. Treatment of residual gland. Ligation of the vessels at the level of excision should be carried out prior to the resection of the thyroid gland. Suitable pressure should be applied on the posterior portion of the thyroid gland with finger tips to lessen bleeding. The wound surface is sutured interruptedly with 000 fine silk.
7. Close of incision. 000 fine silk is used for suturing the platysma and skin separately. Small and sharp cutting needle should be used to suture the skin.
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