Name of the Procedure:

Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy

Summary

A partial thyroid lobectomy, unilateral, with contralateral subtotal lobectomy, including isthmusectomy, is a surgical procedure where one lobe of the thyroid gland is partially removed along with most of the other lobe and the isthmus (the connecting tissue between the two lobes).

Purpose

This procedure is performed to treat thyroid conditions such as benign thyroid nodules, hyperthyroidism, or thyroid cancer. The goal is to remove abnormal thyroid tissue while preserving as much healthy tissue as possible to maintain thyroid function.

Indications

• Presence of thyroid nodules (benign or malignant)
• Hyperthyroidism not responsive to other treatments
• Effectively controlling thyroid cancer
• Goiter causing symptoms such as difficulty swallowing or breathing

Preparation

• Fasting for a specified period before the surgery
• Discontinuing certain medications, as directed by the healthcare provider
• Undergoing blood tests, thyroid function tests, and imaging studies such as ultrasound or CT scan

Procedure Description

1. The patient is placed under general anesthesia.
2. A small incision is made in the lower front part of the neck.
3. The surgeon carefully identifies and protects critical structures such as the recurrent laryngeal nerve and parathyroid glands.
4. One thyroid lobe is partially removed, and most of the opposite lobe is excised along with the isthmus, ensuring the removal of the problematic tissue.
5. Surgical tools may include scalpels, forceps, clamps, and electrocautery devices.
6. The incision is closed with sutures or surgical glue.

Duration

The procedure typically takes between 1 to 3 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon (specialized in thyroid or endocrine procedures)
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to the recurrent laryngeal nerve, potentially causing hoarseness or voice changes
• Hypothyroidism, necessitating lifelong thyroid hormone replacement
• Damage to the parathyroid glands, leading to low calcium levels (hypocalcemia)

Benefits

• Removal of abnormal or cancerous thyroid tissue
• Relief from symptoms associated with thyroid nodules or goiter
• Stabilizing or controlling hyperthyroidism Expected benefits can be realized immediately after recovery or over several weeks.

Recovery

• Hospital stay usually lasts 1-2 days, but sometimes it's an outpatient procedure.
• Pain management using prescribed medications.
• Instructions to avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments for wound check and thyroid function tests.
• Temporary voice changes or sore throat may occur.

Alternatives

• Radioactive iodine therapy for hyperthyroidism or small thyroid cancers.
• Medication to manage hyperthyroidism.
• Fine needle aspiration biopsy or repeat ultrasonography for benign thyroid nodules.
• Pros and cons of these alternatives vary based on the condition's severity, the patient's health status, and personal preferences.

Patient Experience

• During the procedure, the patient is under general anesthesia and won't feel anything.
• After the procedure, the patient may experience some pain, swelling, and bruising in the neck area.
• Pain can be managed with medications, and most discomfort typically resolves within a few days.
• Normal activities can usually be resumed within a week, with full recovery in a few weeks.