经腋窝与胸前径路da Vinci Si机器人甲状腺腺叶切除二例

Technical particularities of robotic-assisted thyroidectomy by a axillary approach or anterior chest approach： a report of two cases

目的 探讨da Vinci Si机器人甲状腺手术不同径路的安全性.方法 2014年1月济南军区总医院用da Vinci Si外科手术系统完成甲状腺腺叶切除2例.1例取腋窝径路,于患侧腋窝沿腋前线取切口约5 cm,对侧锁骨中线乳头上方取横切口约8 mm,建立皮下隧道至术区,经腋窝切口置入da Vinci Si外科手术系统摄像臂及1、2号器械臂,经8 mm trocar置入3号器械臂.另一例取胸前径路,于胸骨切迹下约12 cm处建立观察孔12 mm,双侧锁骨中线乳晕上方处建立操作孔8 mm,观察孔置入摄像臂,操作孔置入1、2号器械臂,术中止血及腺体切除均采用超声刀,标本用取物袋取出,术毕于术区留置负压引流管并关闭手术切口.结果 2例患者均成功实施机器人甲状腺腺叶切除术,无中转开放或腔镜手术,无手术并发症,术中估计出血量10 ～20 mL,平均手术时间为163 min,平均引流量90.5 mL.病理诊断分别为结节性甲状腺肿和甲状腺滤泡性腺瘤.术后测甲状旁腺素及血清钙磷均在正常范围.结论 经腋窝与胸前径路机器人甲状腺腺叶切除安全可行,手术美容效果好.

Objective To evaluate the clinical application and superiority of da Vinci Si surgical system in thyroidectomy.Methods Robotic-assisted thyroidectomy was done for two patients in Jinan Military General Hospital of PLA on January 23 and 24,2014.In one patient,a 5 cm vertical skin incision as well as a 8mm transverse incision were performed in the anterior affected sideaxillary fold and the middle of the contralateral chest wall,respectively.Patient positioned and working space established prior to docking the robot.The camera and working arms are then positioned.The camera arm is centered in the working space.Two working arms are then placed adjacent to the camera.The third working arm is placed through the small medially place incision.In another patient,robotic-assisted thyroidectomy by the anterior chest approach was taken.Focus scalpel was used for hemostasis and gland resection,and dissected tissues were took out by a specimen pouch.Vacuum-assisted closure was placed and then suture incision was made after pathology confirm benign in operation.Results Unilateral thyroidectomy in two patients were successfully performed by da Vinci Si surgical system.There were no operation related complications and without conversions to open or endoscopic surgery.Blood lose during operation was about 10-20 mL.Mean operation time was 163 minutes and postoperative drainage volume was 90.5 mL.Pathological diagnosis were nodular goiter and thyroid follicular neoplasia.Parathyroid hormone,serum Ca and P were measured postoperative and the level were in the normal rage.Conclusion Robotic-assisted thyroidectomy using a axillary approach or anterior chest approach is a safe,feasible,and cosmetically good procedure.