All operations were performed by a team led by
the same consultant surgeon. Surgical access was either
via a standard central collar-line incision or via a lateral
approach.(8) The recurrent laryngeal nerve was identifi ed
and preserved in all cases, unless it was obviously
involved by tumour. Identifi cation and preservation of
the external branch of the superior laryngeal nerve was
attempted in all operations. During each procedure, there
was an attempt to identify and preserve both parathyroid
glands. Autotransplantation of parathyroid tissue into the
sternocleidomastoid muscle was performed if there was
suspicion or evidence of disruption of parathyroid blood
supply. Isthmusectomy was performed with coagulation
diathermy; the divided isthmus was not sutured. In most
cases, a small tube drain was sited at the thyroid bed and
brought out through a separate stab incision. The drain
was removed when less than 20 ml was collected in the
preceding 24 hours. Skin closure was performed with
subcuticular absorbable sutures.