Surgery of the thyroid gland.

Total thyroid lobectomy is feasible with minimal morbidity utilizing a surgical procedure that commences at the inferior pole of the thyroid gland to identify the recurrent laryngeal nerve as the initial step. The superior pole vessels are carefully ligated as the last step, care being taken to avoid the external branch of the superior laryngeal nerve. The parathyroid glands can be easily identified and preserved, and if necessary they can be reimplanted in thin sections in either a strap muscle, sternocleidomastoid muscle, skin incision, or skin of the forearm. Muscle implantation is not performed when the diagnosis is carcinoma, since subsequent operations may require resection of the muscle.