After the middle and inferior veins have been ligated and the superior pole freed by either method, the next step is to expose the inferior thyroid artery. Traction is maintained anteriorly and medially as the artery is exposed on the lateral inferior surface of the gland (Figure 31). A narrow retractor is inserted laterally, and by gauze dissection the lateral aspect of the gland in the region of the inferior thyroid artery is visualized clearly. It should be remembered, especially in the presence of a large gland that has been displaced outward, that the recurrent laryngeal nerve may be much higher in the wound than ordinarily is anticipated. If a total lobectomy or extensive removal of thyroid tissue is indicated, it is necessary, by careful dissection, to identify this nerve, which may run between the bifurcation of the inferior thyroid artery as it enters the gland. The fossa posterior of the gland should also be inspected to determine, if possible, the location of the parathyroid glands, which are usually a pinkish chocolate color. Before commencing this dissection, it is wise to place hemostats on the vessels at the margins of the gland where the major branches of the inferior thyroid artery lie. The application of paired clamps to the major blood vessels at a safe distance from the region of the recurrent laryngeal nerve (Figure 32) defines the amount of thyroid tissue that will remain and lessens the chance of accidental injury to the nerve. With the trachea in view and the gland lifted into the wound, another row of small, curved hemostats is placed well into the parenchyma so that the desired amount of thyroid tissue is retained along with the posterior capsule (Figure 33). The amount of thyroid tissue allowed to remain in relation to recurrent laryngeal nerve is illustrated in Plate 184.