The center of the thyroid lobe is transfixed with a heavy (2-0) figure of eight suture and retracted medially. Retraction of the lobe by penetrating clamps is often bloody, tears the tissue and the bulk of the instrument gets in the way. The middle thyroid veins are carefully isolated from the areolar carotid sheaths, ligated and divided. Mobilization of the posterior surfaces is then completed again using two fingers. If thorough exploration of the opposite lobe is indicated, that middle thyroid vein is also divided.
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