io6 Surgical Diseases and Surgery of the Dog 



It becomes then necessary, in considering operative measures on 

 the thyroid gland, to speak of unilateral and complete thyroidectomy, 

 and unilateral and complete external and internal parathyroidec- 

 tomy or extirpation of the thyroid glandules. 



UNILATERAL THYROIDECTOMY. 



Unilateral Thyroidectomy, without regard to conservation of the 

 glandules, is carried out as follows : Make the skin incision in the 

 median line. This enables the operator to get down easily between 

 and without severing the muscles, which is conveniently done by 

 tearing with the finger or with the aid of a blunt instrument. The 

 lobes are found one on each side under the sternothyroid muscles. 

 Their mobility and slipperiness make their removal somewhat diffi- 

 cult. Draw the lobe up out of the wound by means of a suture 

 passed through it, and secure the ramifications of the superior thyroid 

 artery with a ligature, including the tissue surrounding them, apply 

 another ligature around the anastomosing termination of the inferior 

 thyroid, and, lastly, divide all the attachments on the distal side of 

 the ligatures, leaving as small a stump as possible. It is worthy of 

 note that the necessity of maintaining an aseptic wound in thyroid 

 operations was particularly emphasized by Munk in his experiments, 

 and latterly by Halsted, who found it expedient to devise his "sub- 

 cuticular suture." 



SIMPLE THYROIDECTOMY. 



Simple Thyroidectomy, leaving the glandules intact, is thus de- 

 scribed by Gley (translation) : When the glandules are isolated at the 

 superior or inferior extremity of the gland the operation is not dif- 

 ficult. But this disposition is not the most frequent, consequently it is 

 often necessary to explore for and enucleate them from the thyroid 

 body. Secure the superior and inferior extremities of the lobes by 

 two separate sutures. One of these sutures may often be made to 

 include the thyroid artery, but it is particularly essential that the 

 minute vessel which detaches itself to furnish the glandule be left 

 free. By means of these two sutures have an assistant draw up the 

 lobe in such manner as to render the glandule visible. Separate the 

 latter little by little from the adjacent tissues with a blunt instru- 

 ment. Now pass a fine ligature behind it, but in such a manner as 



