6On the left side, the left recurrent laryngeal nerve assumes a straight course confined to the tracheoesophageal groove. The inferior thyroid artery must be isolated and divided, with careful attention given to the nerve. On both the right and left sides, the preferred technique is to ligate and divide the terminal branches of the inferior thyroid artery nearly flush with the thyroid gland, thereby staying medial to the recurrent laryngeal nerve. Once all of the vascular connections have been securely ligated and divided, the thyroid gland can be mobilized from the airway. The area of greatest concern is at the upper aspect of the recurrent laryngeal nerves where they connect with the junction of the trachea and larynx. Once the fixation of the upper and lateral aspects of the thyroid is completed, attention is then focused on the substernal component.