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Thyroidectomy under local anaesthesia: experience with giant goitres

the conventional site because of the possibility of burrowed skin from the upper part of the chest in patients with giant goiters. After deepening the incision down to the platysma, the upper flap is raised as far as the thyroid notch and the lower flap down to the suprasternal notch. The investing fascia is then incised vertically in the midline which can sometimes be difficult to identify because of the distorted anatomy. After separating the strap muscles at the midline, traction has to be done with care. Mobilization of the thyroid gland may not be difficult in these giant goiters but sometimes difficulty is encountered and the strap muscles may have to be divided, and repaired later. Extra care is required in thyroid gland mobilization especially when done under local anaesthesia and traction on the trachea should be gentle to avoid laryngeal spasm. Routine identification of the blood vessels (including new unusual vessels in some of these giant goiters), ligation and division is done before excision of the gland. Usually the superior thyroid vessels were ligated close to the thyroid gland to avoid injury to the superior laryngeal nerve and the inferior thyroid vessels away from the thyroid gland to avoid injury to the recurrent laryngeal nerves. There was continuous conversation with the patients during the procedure. This encouraged phonation and ensured the integrity of the recurrent laryngeal nerve. After securing haemostasis, drain was left insitu and wound closed, using subcuticular nylon for the skin. Results