Right Hemithyroidectomy
TK Pandian; Roy Phitayakorn, MD
Massachusetts General Hospital
Hemithyroidectomy, or unilateral thyroid lobectomy, refers to removal of half the thyroid gland. The procedure is typically performed for suspicious thyroid nodules or small differentiated thyroid cancers based on biopsy via fine needle aspiration (FNA) and occasionally for symptomatic benign thyroid nodules.
At most institutions the operation can be completed safely in an outpatient fashion with patient discharge from the hospital the same day. It is typically performed via a transcervical collar incision, but endoscopic, transoral routes and remote access approach with robotic instrumentation have been described. The procedure involves mobilization of the thyroid lobe, ligation of thyroid vessels, preservation of parathyroids, protection of the recurrent laryngeal nerve, and dissection away from the trachea. In this patient, a thyroid nodule was detected and found to have indeterminate features on biopsy via FNA. A hemithyroidectomy was then performed for diagnostic purposes.
Lateral Patient Positioning for Shoulder Arthroscopy
Liam A. Peebles; Zachary S. Aman; Matthew T. Provencher, MD
Massachusetts General Hospital
Diagnostic shoulder arthroscopy or arthroscopic shoulder stabilization procedures can be performed with the patient in the beach chair or lateral decubitus (LD) position. Patient positioning may be dictated by surgeon preference or the specific intended procedure; however, LD setup has been found to result in lower rates of recurrent instability in cases of anterior arthroscopic stabilization procedures. The lateral and axial traction provided by the LD setup allows for lower suture anchor placement on the anterior-inferior aspect of the glenoid, as the surgeon has increased visualization and working room within the glenohumeral joint.
Prior to placing the patient in the LD position, meticulous care must be taken to properly position the beanbag device and set up the lateral traction device. Next, a coordinated team approach should be used to roll the patient into the LD position and to ensure that all bony prominences are adequately padded. The shoulder is then placed in 40° of abduction, 20° of forward flexion, with 10–15 pounds of balanced traction. Finally, the shoulder is prepped and draped in the usual sterile fashion and the surgeon is then able to proceed with the necessary arthroscopic procedure.
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