1.Anesthesia: Cervical plexus anesthesia or general anesthesia can be used. 2. Position: Use shoulder pads, head tilted back, and head ring, but do not tilt the head back too much, as this will make the patient prone to head and neck discomfort or headache after surgery. Take the reverse Trendelenburg position, that is, the operating table is tilted about 20 degrees, head high, feet bottom, so as to reduce the venous pressure in the neck. 3. Incision: Generally take 1.5-2 horizontal fingers on the sternal stalk incision or take the appropriate neck skin fold, but not too low, not on the clavicle, too low postoperative scars will widen or form scar bumps. The length of the incision is usually 4-6 cm, in an arc, and the incision should be symmetrical. Do not make the incision long on the left side because of the left lobe excision and vice versa, which is contrary to the cosmetic principle, but make sure to make the incision symmetrical on both sides. 4.Free flap: Separate the flap on the deep side of the broad neck muscle and the superficial side of the anterior jugular vein, and use an electric knife or scalpel to combine sharpness with bluntness. The upper flap was separated to the thyroid cartilage notch and the lower flap was separated to the sternal stalk notch. 5.Open the cervical white line with electrocoagulation. Generally, the cervical white line is wider at the sternal stalk, so it can be found easily by looking for the cervical white line in the lower part first. Upward to the thyroid cartilage, the cervical white line is completely opened to reveal the isthmus of the thyroid gland. In general, tissue forceps or intestinal forceps (appendiceal forceps) can be used to lift both sides of the sternocleidomastoid muscle upward, so that it is easy to open the cervical white line. Separate the anterior cervical muscles (medial sternocleidomastoid muscle, slightly lateral sternocleidomastoid muscle and deeper sternocleidomastoid muscle), usually without disconnecting the anterior cervical muscles. The lax tissue between the sternocleidomastoid muscle, sternocleidomastoid muscle and thyroid gland is freed with fingers or “peanut butter”. If the tumor is large, in order to reveal the thyroid gland, sometimes the anterior cervical muscle group should be separated, and the separation should be as much as possible by the upper part, so that the nerve to muscle nutrition can be retained as much as possible. 7. Free the lobe of the gland: you can free the upper pole first or free the lateral side to sever the middle thyroid vein and then free the upper pole. Generally, most of them are separated from the middle vein and then from the superior pole. The anterior cervical muscles are pulled outward with a hook, and the sternocleidomastoid muscle is pulled out together, not just the sternocleidomastoid muscle, while the thyroid tissue is clamped with an intestinal forceps (appendiceal forceps) or straight vascular forceps, and the lobe is pulled inward and forward, or a gauze is wrapped around the finger and pushed inward and upward away from the lobe. When pulling the anterior cervical muscles and the lobe of the gland, be gentle, do not use violence, otherwise it is easy to tear the middle vein. The lax tissue between the lateral posterior aspect of the lobe and the carotid sheath is separated with “peanut butter” or right-angle forceps and the middle thyroid vein is encountered, which may be one or more branches or absent. The middle vein is ligated and severed immediately adjacent to the lobe of the gland. Further upward freeing is done to the lateral aspect of the superior pole. At this point, the sternocleidomastoid muscle is drawn upward and inward so that the lateral aspect of the superior pole is easily and completely free. If the sternocleidomastoid muscle affects the freeing of the superior pole at this point, part of the muscle can be cut off at the stop of the thyroid cartilage of the muscle so that it helps to reveal the superior pole and cutting off the muscle will not have any effect. At this point, the gap between the superior pole medially and the cricothyroid muscle (cricothyroid gap) should be separated. The cricothyroid muscle is severed from the superior pole medially by cutting the loose tendon, which usually has a small blood vessel passing through it and can be ligated and cut. Clamp the superior pole thyroid tissue with vascular forceps or intestinal forceps (appendicular forceps, also called Babcock forceps), pull downward and outward, and separate the gap between the superior pole and the cricothyroid muscle with right-angle forceps tightly against the medial side of the superior pole to free the superior pole vessels, not close to the cricothyroid muscle to separate the gap, otherwise the lateral branch of the superior laryngeal nerve is easily damaged. Ligate and cut the superior pole vessels immediately against the superior pole of the thyroid, and do not ligate the superior pole in large pieces or away from the superior pole of the thyroid, as this can easily damage the lateral branch of the superior laryngeal nerve. Further pull the superior pole inward and upward to separate the posterior medial aspect of the superior pole. At this time, care should be taken not to remove or damage the superior parathyroid gland and free the superior parathyroid gland from the surgical field. Pay attention to its blood flow. 8. After the upper pole is free, the recurrent laryngeal nerve should be revealed and the inferior thyroid artery should be disconnected. Further pull the thyroid gland inward and forward to free its lateral posterior and reveal the inferior thyroid artery (note that the inferior artery enters the thyroid gland not at the inferior pole but at the middle and lower side of the gland lobe through the branches, at this time the recurrent laryngeal nerve travels behind the trunk or branches of the inferior artery, or it can travel in front of the artery. Care should be taken not to ligate the main trunk of the inferior artery (some domestic textbooks and surgical texts say to ligate the main trunk, but abroad it is strictly forbidden to ligate the main trunk because the blood supply to the parathyroid gland comes from the inferior artery, and if the main trunk is ligated, the parathyroid gland is prone to ischemia), but to ligate the tertiary branches of the inferior artery close to the thyroid gland so as to preserve the blood supply to the parathyroid gland to the greatest extent possible, and here it is easy to damage the recurrent laryngeal nerve. The ligation of all “wire-like” structures should be done only when it is not a nerve. After the laryngeal nerve is found here, the laryngeal nerve is exposed along the tracheoesophageal groove upward to its entry point (the lower edge of the cricothyroid muscle), so that it is exposed throughout to prevent injury. 9. Free the inferior pole: cut the inferior thyroid vein immediately adjacent to the thyroid gland (note that the inferior vein enters the inferior pole and the inferior artery does not enter the inferior pole), and sometimes there is also the inferiormost thyroid artery, which should also be cut. 10. At this point, the thyroid gland is fixed to the trachea only by the thyroid suspensory ligament (also called Berry’s ligament) (the suspensory ligament is at the cricoid cartilage and the upper tracheal cartilage). The ligament is the most easily damaged step of the recurrent laryngeal nerve. Since the recurrent laryngeal nerve passes inside or behind the ligament, the relationship between the recurrent laryngeal nerve and the ligament is close, and there are small blood vessels passing through the ligament, the ligament should be ligated when it is cut or it will bleed easily. The electric knife should not be used to prevent electrical injury to the recurrent laryngeal nerve. After cutting the suspensory ligament, the glandular lobe is further lifted upward and inward, the thyroid gland and the isthmus are cut off with an electric knife and the loose tissue in front of the trachea, the isthmus is cut off in the contralateral lobe, the residual short 8 suture is ligated, and the glandular lobe and isthmus are completely removed. 10. Check the surgical field, rinse the surgical field with warm saline, and stop the bleeding carefully. Bleeding points near the recurrent laryngeal nerve cannot be stopped by electrocoagulation, but can be stopped by compression, or ligated to stop the bleeding if the nerve is visible. Small bleeding points can be compressed and then sprayed with protein gel to stop bleeding. 11, 2 0 or 0 silk sutures intermittently close the cervical white line, 4 0 absorbable sutures close the broad cervical muscle and intradermal sutures close the skin. Fine drainage tubes can be used for drainage (or skin slice drainage), but drainage is not routinely put abroad, but mostly put in China and removed after 24 hours.