Name of the Procedure:

Excision of cyst or adenoma of thyroid, or transection of isthmus

Summary

This surgical procedure involves the removal of a cyst or adenoma (a benign tumor) from the thyroid gland, or the cutting and removal of the thyroid isthmus, which is the thin band of tissue connecting the two lobes of the thyroid gland.

Purpose

The procedure targets conditions like thyroid cysts or adenomas that may be causing symptoms or have the potential to grow larger. The primary goal is to alleviate symptoms, prevent potential complications, and diagnose or rule out cancer if present.

Indications

• Enlarged thyroid cyst or adenoma
• Difficulty swallowing or breathing due to the growth
• Suspicion of cancer
• Cosmetic concerns or discomfort due to the size of the growth
• Hyperthyroidism, if the adenoma is producing excess thyroid hormones

Preparation

• Fasting for at least 8 hours before the procedure.
• Medication adjustments as advised by the doctor.
• Preoperative blood tests and imaging studies like ultrasound or CT scan.
• Consultation with the anesthesiologist to discuss anesthesia options.

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the neck.
3. The surgeon identifies the thyroid gland and the cyst or adenoma.
4. The cyst or adenoma is carefully removed without causing damage to surrounding tissues.
5. If the isthmus is involved, it is located and transected.
6. The surgical site is examined for bleeding.
7. The incision is closed with sutures.
8. A drain may be placed to prevent fluid accumulation.

Tools: Scalpel, forceps, retractors, sutures, electrocautery device. Anesthesia: General anesthesia is typically used.

Duration

The procedure usually takes between 1 to 3 hours, depending on the complexity and extent of the surgery.

Setting

• Hospital operating room
• Surgical center specialized in thyroid procedures

Personnel

• General surgeon or ENT (ear, nose, and throat) specialist
• Surgical nurse
• Anesthesiologist
• Surgical technologist

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma
• Injury to surrounding structures, such as the nerves controlling the vocal cords or parathyroid glands
• Temporary or permanent hypocalcemia (low calcium levels)
• Scar formation

Benefits

• Relief from symptoms like difficulty swallowing or breathing
• Removal of potentially precancerous or cancerous lesions
• Improved cosmetic appearance and comfort
• Normalization of thyroid hormone levels if the adenoma was causing hyperthyroidism

Recovery

• Hospital stay of 1 to 2 days, depending on recovery speed.
• Pain management with prescribed medications.
• Instructions for wound care and activity restrictions.
• Follow-up appointments for suture removal and assessment of thyroid function.
• Full recovery typically occurs within 2 to 4 weeks.

Alternatives

• Watchful waiting with regular monitoring for small, asymptomatic cysts or adenomas.
• Fine needle aspiration to drain the cyst.
• Radiofrequency ablation for cysts that recur after aspiration.
• Medical management for hyperthyroidism if a thyroid adenoma is present.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel anything. Post-procedure, the patient might experience sore throat, mild neck pain, and some swelling at the incision site. Pain can be managed with medications, and the discomfort typically subsides within a few days. Regular follow-up ensures that recovery progresses smoothly.