经口腔达芬奇机器人甲状腺手术初步经验

Transoral robotic thyroidectomy: a preliminary report of 5 cases in China

目的探寻通过达芬奇机器人技术进行经口腔甲状腺切除术(transoral robotic thyroidectomy,TORT)是否可行并报道初步的经验教训。方法从2017年9月到12月,在北京和睦家医院进行了5例TORT。使用了3个完全口内切口连接达芬奇机器人手臂3个端口,回顾性分析手术结果。结果 5例均为女性患者(平均年龄30岁,平均肿瘤大小2. 0 cm),其中行单侧甲状腺腺叶切除4例、全切1例,3例行中央颈清扫。其中3例甲状腺乳头状癌(papillary thyroid carcinomas,PTC)、1例甲状腺滤泡癌、1例甲状腺良性腺瘤。平均手术时间为343 min。PTC患者中央淋巴结数目平均为8. 7枚。术后没有短暂性声带麻痹和低钙症状,3例患者术后有下唇感觉减退和感觉异常、1例因镜头接触发生皮瓣Ⅰ度烫伤。结论 TORT对于选择的甲状腺肿瘤患者初步尝试是可行的,是无瘢痕甲状腺手术选择之一。

Objective To explore the feasibility of transoral robotic thyroidectomy （TORT） and present the experience and lessons from the initial 5 consecutive patients. Methods From Sep. to Dec.2017, we performed TORT at Beijing United Family hospital using three intraoral ports for the da Vinci system′s three robotic arms. Results Among five patients （mean age 30 years; mean tumor size 2.0 cm）, four underwent unilateral thyroid lobectomies and one did total thyroidectomy with or without central neck dissection. Three patients had papillary thyroid carcinomas （PTC）, one had a follicular thyroid carcinoma and one had thyroid adenoma. The mean surgical time was 343 min. The mean number of retrieved central lymph nodes in the PTC patients was 8.7. There were no observed transient or permanent vocal cord palsy and hypocalcemia postoperatively. However,paresthesia of the lower lip and the chin was observed in the first three patients and one patient had skin flap first degree burn due to lens. Conclusions TORT is feasible for selected patients and would be a potential alternative approach for scarless thyroid surgery.