. Manual of operative surgery. From this step on, throughout the operation,until the last vessel has been divided, the thyroid lobe must be firmly drawntowards the opposite side, alternate relaxation and compression and unduepressure on the trachea being carefully avoided. From above downwards andfrom before backwards the vessels as they bind or as they present must beclamped and divided at their point of entrance into the gland, as far peripherallyas possible. Except in the case of the larger branches it is usually unnecessaryto clamp the distal end of the cut vessel, hemorrhage from the glan
. Manual of operative surgery. From this step on, throughout the operation,until the last vessel has been divided, the thyroid lobe must be firmly drawntowards the opposite side, alternate relaxation and compression and unduepressure on the trachea being carefully avoided. From above downwards andfrom before backwards the vessels as they bind or as they present must beclamped and divided at their point of entrance into the gland, as far peripherallyas possible. Except in the case of the larger branches it is usually unnecessaryto clamp the distal end of the cut vessel, hemorrhage from the gland side being 262 goitre; bronchocele; struma prevented by the pressure exerted on the thyroid lobe by the unremittingtraction towards the opposite side of the neck. By this method the recurrentlaryngeal nerve, usually seen, is little endangered. In the course of the libera-tion of the lobe the nerve may be dragged well to the front of the trachea; ofthe right nerve this is particularly true. When in the immediate neighborhood. Fig. 395.—{Balfour, Annals of Surgery.) of this nerve, at what might erroneously be termed the hilus of the th>Toid lobe,one plunges the sharp-pointed clamps into the thyroid gland, seizing the bindingvessels after they have disappeared from view in its substance. WTien the habitis well acquired, little if any time is lost by practising the clean, bloodless methodof operating for goitre. The operation can be carefully performed in about thetime required for its detailed description. RESECTION 263 Method D.—Angular Incision (Kocher).—Beginning on the sternomastoidmuscle at the level of the thyroid cartilage, make an incision through the skinand platysma, reaching the median line and following the direction of the natu-ral folds or creases of the skin. Continue the incision downwards in the middleline to the notch of the sternum. Reflect the angular skin-flap and expose thesternomastoid, which must be retracted outwards. The rest of the operationis
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