Lesson 1Intraoperative strategy for recurrent laryngeal nerve identification and preservationDescribes systematic approaches to identify and protect the recurrent laryngeal nerve, including anatomical variants, dissection planes, use of capsular technique, handling of difficult scarring or reoperations, and responses to intraoperative nerve injury.
Key anatomic landmarks of the RLNInferior, lateral, and superior approachesCapsular dissection and safe planesManaging scarring and reoperative fieldsHandling suspected nerve injuryLesson 2Management of common complications: hypocalcemia, vocal cord palsy, wound infection, and seromaAddresses early complications after thyroidectomy, including hypocalcaemia, vocal cord palsy, wound infection, and seroma, with emphasis on recognition, diagnostic workup, acute management, patient counselling, and indications for specialist referral.
Recognition and treatment of hypocalcemiaEvaluation of vocal cord dysfunctionPrevention and care of wound infectionSeroma prevention and aspiration techniquePatient education and follow‑up planningLesson 3Selection of operative approach: hemithyroidectomy, total thyroidectomy, completion thyroidectomyDetails criteria for choosing hemithyroidectomy, total, or completion thyroidectomy, integrating tumour features, risk stratification, prior surgery, patient preference, and guidelines, plus counselling on risks, benefits, and long-term endocrine follow-up.
Oncologic and benign disease indicationsRisk stratification and guideline useWhen to choose hemithyroidectomyIndications for total or completion surgeryShared decision making with patientsLesson 4Lymph node management: central compartment dissection indications and extentReviews indications and extent of central neck dissection in thyroid cancer, including anatomical boundaries, oncologic rationale, prophylactic versus therapeutic dissection, technical steps, and strategies to minimise nerve and parathyroid injury.
Central compartment anatomy and nodal levelsOncologic indications for central neck dissectionProphylactic versus therapeutic dissectionTechnical steps and key landmarksProtecting nerves and parathyroid glandsLesson 5Identification, preservation, and autotransplantation of parathyroid glandsExplains strategies to identify and preserve parathyroid glands, including typical and ectopic locations, vascular supply, techniques to avoid devascularisation, criteria for autotransplantation, grafting methods, and postoperative functional assessment.
Recognizing normal and ectopic parathyroidsMaintaining parathyroid blood supplyWhen to perform autotransplantationAutotransplantation sites and techniqueAssessing postoperative parathyroid functionLesson 6Hemostasis techniques, use of energy devices, and management of problematic bleedingFocuses on meticulous haemostasis in thyroidectomy, comparing suture ligation, clips, and energy devices, safe use near nerves and parathyroids, prevention of neck haematoma, and stepwise management of unexpected or brisk bleeding.
Vascular anatomy relevant to hemostasisSuture ligation and clip techniquesTypes and settings of energy devicesSafe use near nerves and parathyroidsAlgorithm for intraoperative bleedingLesson 7Anesthesia considerations and perioperative optimization including anticoagulation managementCovers anaesthesia planning for thyroid surgery, airway evaluation, intubation strategies, management of comorbidities, perioperative anticoagulation and antiplatelet adjustment, fluid and blood pressure targets, and postoperative pain and nausea control.
Airway assessment and intubation planningManagement of comorbid conditionsAnticoagulation and antiplatelet adjustmentIntraoperative hemodynamic and fluid goalsPostoperative analgesia and nausea controlLesson 8Calcium and PTH monitoring protocols after thyroidectomy and initiation of thyroid hormone replacementCovers protocols for postoperative calcium and PTH testing, risk stratification for hypocalcaemia, oral and intravenous calcium and vitamin D regimens, timing of thyroid hormone initiation, and dose adjustment based on TSH and risk profile.
Timing of calcium and PTH measurementsRisk stratification for hypocalcemiaOral and IV calcium and vitamin D regimensInitiating levothyroxine after surgeryTSH targets and dose adjustment plansLesson 9Role and practical use of intraoperative nerve monitoring: indications, limitations, and alternativesExplores intraoperative nerve monitoring principles, indications, and setup, including electrode placement, stimulation protocols, troubleshooting signal loss, interpretation of EMG changes, limitations, and safe alternatives when monitoring is unavailable.
Basic principles of nerve monitoringIndications and patient selectionEquipment setup and troubleshootingInterpreting EMG signals and alertsSurgery without monitoring: safe strategiesLesson 10Immediate postoperative monitoring: airway, hematoma recognition and management algorithmsOutlines immediate postoperative monitoring after thyroidectomy, focusing on airway assessment, early detection of neck haematoma, standardised observation protocols, escalation pathways, and stepwise algorithms for bedside and operative management.
Postanesthesia airway assessment stepsNeck wound checks and early warning signsHematoma risk factors and preventionBedside decompression and emergency stepsCriteria for urgent return to the OR
