1. 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

11. Positioning

12. Opening of strap muscles exposing the thyroid thyroid

13. Left lobe thyroid Left rec laryngeal nerve Inferior parathyroid

14. Stony hard Rt lobe thyroid

15. Tumor bed over trachea after tumor shaved off CCA Thyroid cartilage

16. Sling to encricle the trachea

17. Dividing the trachea above the tumor bed

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

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

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

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

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

23. After anastomoses Tension relaxing sutures

26. Suture bite to keep the neck in flexed position

27. Surgical Specimen-anterior view

28. Surgical Specimen-posterior view

29. Resected trachea-anterior view

30. Resected trachea-inner view growth

36. Patient discharged and planned for RAI therapy