. Manual of operative surgery. T:oid and bring it into the necessary make an incision along the outer posterior border of the thyroidso as to divide any condensed areolar tissue which may be adherent to theperitoneal-like investment of the gland. This incision is not always necessary. 26o goitre; bronchocele; struma With a piece of gauze wipe or brush all areolar tissue adherent to the posteriorsurface of the gland from the gland so that that surface of the gland has nomoss of areolar tissue left adherent to it, but presents a smooth peritoneal-like appearance. If this is done careful
. Manual of operative surgery. T:oid and bring it into the necessary make an incision along the outer posterior border of the thyroidso as to divide any condensed areolar tissue which may be adherent to theperitoneal-like investment of the gland. This incision is not always necessary. 26o goitre; bronchocele; struma With a piece of gauze wipe or brush all areolar tissue adherent to the posteriorsurface of the gland from the gland so that that surface of the gland has nomoss of areolar tissue left adherent to it, but presents a smooth peritoneal-like appearance. If this is done carefully and every bit of areolar tissue, whichmay have penetrated into sulci on the gland surface, has been brushed off andleft adherent to the fibrous capsule, then the parathyroids must also have beenbrushed off and preserved. Continue this gauze dissection or brushing to the. ii*- sgo—O^^y^-) middle line. Ligate the inferior thyroid artery close to the tumor as the gauzedissection is being carried out. This leaves the recurrent laryngeal nervebehind and usually out of sight. Steps 4, 5 and 6.—As in method A. Method C.—Halsteds operation is the same as Kochers or Mayos up toa certain point. The following quotation from Halsted gives the main pointsof his method. Contrary to the universal custom, I do not, as a rule, completeat this moment the full delivery of the entire gland, for fear of soiling, butgrasp very firmly between the thumb and finger the superior pole and pull itforwards and towards the mid-line far enough to make the ultraligation of thesuperior thyroid vessels perfectly easy. Attempts to completely dislocate the HALSTED S OPERATION 261 entire gland of the inferior pole in this manner at this stage of the operationmay cause the rupture of some delicate blood-vessels and consequent stainingof the field containing the parathyroid glandules
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