Tải xuống
Tóm tắt
Background: Endoscopic thyroidectomy was performed for the first time in 1997 by Huscher. Nowaday, this procedure is used in many countries around the world. The potential advantages of the endoscopic technique are better cosmetic results and better patient comfort. Endoscopic thyroidectomy via breast- axillary approach with harmonic scalpel is both safe and has cosmetic value.
Objective: To describe endoscopic technique and to evaluate efficacy of endoscopic thyroidectomy via a breast- axillary approach with CO2 insufflation.
Patients and method: Patients were diagnosed with nodular thyroid goiter; prospective study
Results: Since October 2012, we have applied a new technique: endoscopic thyroidectomy for nodular thyroid goiter at Oncology Center, Hue Central Hospital. 108 cases (100 females – 8 males), mean age was 28.2 (range 15 to 53); 98 solitary nodular goiter (90.8%), 9 multinodular at one lobe (8.3%) and 1 multinodular at two lobes (0.9%) underwent partial lobectomy (89.8%) or total lobectomy (9.3%) and near- total thyroidectomy (0.9%). The preoperative diagnosis of thyroid tumors was established using physical examination, fine-needle aspiration cytology, USG neck and FT4, TSH tests. The procedure is performed with the patient at a supine position under general anesthesia with endotracheal intubation. Three trocars are inserted at 3 positions as axilla and breast areola. The working space is created above pectoral muscle advancing towards the subplatysmal plane by monopolar cautery and maintained with a continuous pressure of 10 to 12 mmHg carbon dioxide (CO₂). Thyroid nodule is exposed by dissection through along the SCM anterior border and removed by Harmonic scapel. There were severe postoperative complications such as recurrent laryngeal nerve palsy nor postoperative tetany..; less postoperative pain, earlier return to regular activities, superior cosmetic appearance. Histopathological results were follicular adenomas for 93.1%, 6.9% in all cases were carcinoma. All patients are satisfied with the cosmetic results.
Conclusions: It is a feasible, safe and effective technique. It is possible to achieve in cases: solitary nodular goiter, multinodular goiter, hyperthyroidism and thyroid cancer.
Tài liệu tham khảo
Amaral JF. The experimental development of and ultrasonically activated scalpel for laparoscopic use. Surg Laparosc Endosc 1994;4:92-9.
Gagner M, Rubino F. Endoscopic parathyroidectomy. In: Gagner M, Inabet WB, editors. Minimally invasive endocrine surgery. Lippincott, Williams and Wilkins: Philadelphia; 2002.
Huscher CS, Chiodini S, Napolitano C, Recher A. Endoscopic right thyroid lobectomy. Surg Endosc 1997;11:877.
Ikeda Y, Takami H, Sasaki Y, Takayama J, Kurihara H. Are there significant benefits of minimally invasive endoscopic thyroidectomy? World J Surg 2004;28:1075-8.
Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S. Comparative study of thyroidectomies, endoscopic surgery vs conventional open surgery. Surg Endosc 2002;16:1741-5.
Inabet WB, Jacob BP, Gagner M. Minimally invasive endocrine thyroidectomy by a cervical approach. Early vessel ligation decreases the duration of surgery. Surg Endosc 2003;17:1808-11.
Kitano H, Fujimura M, Kinoshita T, Kataoka H, Hirano M, Kitajima K. Endoscopic thyroid resection using cutaneous elevation in lieu of insufflations. Technical considerations and review of an open series. Surg Endosc 2002;16:88-91.
Miccoli P, Bellantone R, Mourad M, Walz M, Raffaelli M, Berti P. Minimally invasive video-assisted thyroidectomy: Multi-institutional experience. World J Surg 2002;26:972-5.
Miccoli P, Berti P, Raffaelli M, Conte M, Materazzi G, Galleri D. Minimally invasive video-assisted thyroidectomy. Am J Surg 2001;181:567-70.
Palazzo FF, Sebag F, Henry JF. Endocrine surgical technique: Endoscopic thyroidectomy via the lateral approach. Surg Endosc 2006;20:339-42.
Samy A.K., Ridgway D. (2010), "Minimally invasive, video-assisted thyroidectomy: first experience from the United Kingdom", Ann R Coll Surg Engl, 92, pp. 379-384.
Yeung GH. Endoscopic thyroid surgery today: A diversity of surgical strategies. Thyroid 2002;12:703-6.
Puntambekar Shailesh P. Endoscopic thyroidectomy: Our technique. Journal of Minimal Access Surgery 2007;3:91-97.
Zhang W, Jiang J.G. (2010), "The minimally invasive effect of breast approach endoscopic thyroidectomy: an expert’s experience", Clinical Developmental Immunology, Art ID 459143/5.
| Đã xuất bản | 19-08-2016 | |
| Toàn văn |
|
|
| Ngôn ngữ |
|
|
| Số tạp chí | Số 36 (2016) | |
| Phân mục | Nghiên cứu | |
| DOI | ||
| Từ khóa | endoscopic thyroidectomy, breast - axillary approach, CO₂ insufflation |
công trình này được cấp phép theo Creative Commons Attribution-phi thương mại-NoDerivatives 4.0 License International .
Bản quyền (c) 2025 Tạp chí Y học lâm sàng Bệnh viện Trung Ương Huế