I am having trouble decoding this Operative Report. I have a few possible answers but I’m still confused as to the

root operation that is done. can someone take a look and help me out. I attached the OP report as a word document.  ATTACHMENT PREVIEW Download attachmentPREOPERATIVE DIAGNOSIS: Tertiary hyperparathyroidismPOSTOPERATIVE DIAGNOSIS: Tertiary hyperparathyroidismOPERATION PERFORMED: Subtotal parathyroidectomyANESTHESIA: General. Fifteen mL of 0.5% Marcaine with epinephrine for localanesthesiaDESCRIPTION OF OPERATION: The patient was intubated with the nerve monitorendotracheal tube. A shoulder roll was placed and the neck was prepped and drapedin the usual manner. A transverse cervical incision was made, and local anesthesiawas infiltrated prior to the incision and as we finished the closure. The initial incisionwas deep and beyond platysma. Crossing anterior jugular vein branches weredoubly ligated with 2-0 silk ties and divided. The superior subplatysmal flap wasbrought to the thyroid notch and the inferior flap to the sternal notch. Strap muscleswere divided at the midline and separated.The right strap muscles were lifted off the right thyroid gland and mobilized slowlythe right thyroid gland medially. The nerve at the base of the neck was identified.There were two inferior thyroid artery branches that were ligated with 2-0 silk tiesand divided. Middle thyroid vein was ligated with 2-0 silk tie and divided. The thyroidgland was mobilized medially. The right upper parathyroid gland was found at themid aspect of the posterior thyroid gland. It was intrathyroidal. It was slowly removedfrom the thyroid gland, clipped the feeding vessels and the right upper parathyroidgland was totally excised. The nerve was noted to be functional at the end of thisexcision.The superior vascular bundle was doubly ligated with 2-0 silk ties and dividedallowing for further mobilization of the gland medially. We were unable to find aparathyroid gland at that level. We then subsequently freed the lower pole of thethyroid gland and we started identifying the thymus tissue and pulled it out of thechest. There was a right neck lymph node that was submitted for frozen section andthis was benign. We then identified a right lower parathyroid gland. I clipped thedistal half and this was confirmed to be parathyroid tissue. The proximal half of theparathyroid gland was left intact.The left strap muscles were lifted off the left thyroid gland. The middle thyroid veinwas ligated with 3-0 silk ties and divided and the thyroid gland was then mobilizedmedially. The nerve was found at the base of the neck and traced towards the larynx.The left upper parathyroid gland was identified, found to be posterior to the midaspect of the thyroid gland, and it measured 1.5 x 0.8 cm. We freed it from the nerveand from the thyroid gland and this was confirmed to be parathyroid tissue. Thesmall vascular pedicles were clipped and the left upper parathyroid gland removed.The nerve was noted to be functional at this point.We ligated the superior thyroid vascular pedicle. This was done with 2-0 silk ties x2and with a 3-0 silk suture ligature. We mobilized the gland medially, and not finding

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