Thyroidectomy

points marked on suprasternal notch, 1 finger breadth above sc joint and in middle.
skin crease incision made bw 2 scms with blade spread bw 2 fingers
incision deepened with monopolar until platysma seen dividing.
finger used to pull back skin and show sub-platysmal layer and monopolar used to make slipght plane below it.
jolls retractor placed.
platysma held with 3 allis and pulled up.
.flap raised just below the platysma and above the white cervical fascia.
anterior and posterior borders of scm released n the side of snt.
fascia held up with 2 mosquitos and monopolar incised at midline bw 2 ajv.
ajv can be buzzed with bipolar or toothed and monopolar.
2 sterno hyoids split in middle and allis applied to it, lifted up and separated from sternothyroid.
allis re-applied to lift sternothyroid and plabe created above capsule, all the while pulling thy more and more medially.
Retractor put for muscle.
MTV ligated with 3-0 and divided.
1 fascia is at posterior border. bipolar division done. pusher used to free the space in bw pedicles at  posterior border to reach t-o groove.
index finger and thumb used to hold the lobe and pull it down.
above muscle strands divided with monopolar.
pusher used to make space.
right angle makes window laterally and medially.
and 2 ligatures made on superior pedicale with 2-0, not divided.
thin fascia over inferior pole, mosquito dips and opens above pedicle, dips and opens below pedicle, lift up the thin fascia over pedicle, divide with bipolar.
hunt for rln in t-o groove keeping curve upwards. then hunt for it below thy.
once found follow it upto untry point.
ligate STA again and divide with blade.
 bipolar division of berrys very close to thy gland surface from above descend upto isthmus level.