Setup for an Open Total Thyroidectomy (South College, Knoxville, TN)

For every surgical procedure, a sterile, well-organized back table setup is needed to provide surgical efficiency and patient safety. This educational video demonstrates a setup for an open total thyroidectomy. This surgical procedure is performed to treat various conditions. The setup protocol provided here shows how to create the sterile field and position instruments and supplies to allow for quick access while maintaining sterility throughout the procedure.

Total thyroidectomy refers to the complete surgical removal of the thyroid gland and is one of the most commonly performed endocrine surgical procedures worldwide.¹ It is used to treat multiple medical conditions, including thyroid cancer and multinodular goiter with neck compression, toxic goiter that does not respond to treatment, and Graves' disease.^2–4 The success of surgery depends on surgical proficiency and sterile preoperative preparation. A sterile, efficient setup creates the foundation for smooth surgical operations, protects the patient from infection, and allows for quick access to essential surgical instrumentation.

The practice of double-gloving provides an extra level of safety for all members of the surgical team. An indicator glove, worn beneath the outer glove and displaying a contrasting color, allows immediate detection of glove holes or tears so they can be replaced promptly.

The back table is divided into sections: the working end, closer to the patient, for instrumentation and supplies, and the non-working end, farther from the patient, for extra gloves and towels. The kidney-shaped basin contains medicine cups, skin markers, silk ties, syringes, measuring rulers, and additional small surgical instruments.

Patient drapes are arranged in the expected order of use and placed on the Mayo stand, along with a magnetic instrument pad, used to prevent surgical instruments from slipping off the sterile field.

All sponges, sutures, blades, and electrocautery tips must be tracked and counted. The suture management system includes a sharps container for needle counting and a pink pad as a neutral zone to transfer sharp instruments between team members without exposing them to needlestick injuries. The Bovie electrocautery, along with suction tubing and disposable light handle covers, remains inside the sterile area throughout the procedure.

This methodical approach to OR preparation for open thyroidectomy leads to better surgical team performance and patient safety through improved instrument accessibility and strict infection control measures. Verification of sterile technique is performed through visual checks of chemical indicators. The circulating nurse needs to check all sterile packages for any signs of damage or contamination.

The surgical team follows standard protocols to count soft goods (sponges) and sharps (needles and blades), but thyroidectomy procedures do not require formal instrument counts because they do not involve body cavity entry.

Surgical technologists must adapt to surgeon preference in terms of instrumentation while always adhering to aseptic technique to create the sterile field.

The setup in this video gives surgical technology students and others a clear demonstration of how to prepare the operating room for an open total thyroidectomy and reinforces basic skills that apply to many other surgical procedures. Instructional videos can help students to boost their confidence as they move into clinical settings and provide helpful information for those who are re-entering the perioperative field.

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