Ms Kusnur Karim 45/F, case of Papillary thyroid cancer with Tracheal invasion and hemoptysis Bronchoscopy: growth protruding below the vocal cords Underwent Total Thyroidectomy + resection of tracheal rings along with the growth and end- to-end anastomoses of trachea

Positioning

Opening of strap muscles exposing the thyroid thyroid

Left lobe thyroid Left rec laryngeal nerve Inferior parathyroid

Stony hard Rt lobe thyroid

Tumor bed over trachea after tumor shaved off CCA Thyroid cartilage

Sling to encricle the trachea

Dividing the trachea above the tumor bed

ET tube inserted from the distal cut end of trachea Divided portion of trachea

Oesophageal bed from where trachea was removed Upper cut end Lower cut end

CCA Taking bite from lower cut end of trachea Upper cut end

Anastamosing both the proximal and distal cut ends of trachea with ET tube in the lower end

Anastamosing both the proximal and distal cut ends of trachea after removing the ET tube from the distal end

After anastomoses Tension relaxing sutures

Suture bite to keep the neck in flexed position

Surgical Specimen-anterior view

Surgical Specimen-posterior view

Resected trachea-anterior view

Resected trachea-inner view growth

Patient discharged and planned for RAI therapy