无充气单侧腋窝入路全腔镜甲状腺双侧叶全切除术对侧处理改进三步法(附视频)

The improved three-step method for contralateral treatment in gasless unilateral axillary approach-endoscopic total thyroidectomy(with video)

随着腔镜技术的发展,腔镜甲状腺手术也得以广泛应用,目前腔镜甲状腺手术的常见入路有经胸乳、经口、经腋等,其中无充气腋窝入路腔镜甲状腺手术受到众多从事甲状腺外科医生的高度认可。该技术能够满足患者的美容需求,同时能够利用颈前肌肉的自然间隙进行手术达到微创的目的。虽然目前无充气腋窝入路腔镜甲状腺手术操作越来越成熟规范,但是在无充气单侧腋窝入路全腔镜甲状腺双侧叶全切除术(GUA-ETT)过程中,切除对侧叶时,如何避免气管的遮挡、顺利暴露对侧喉返神经并保证对侧中央区淋巴结清扫的彻底性等都是需要直接面对的困难。本中心针对单侧叶切除后行对侧叶全切除术及对侧中央区淋巴结清扫术,提出对侧处理改进三步法。为了更方便甲状腺外科医生掌握该技术,笔者就该GUA-ETT中对侧处理改进三步法的手术方法、技术特点、操作技巧及细节与操作重点、难点及操作经验进行详细阐述及分享。

With the advancements in endoscopic techniques,endoscopic thyroid surgery has become widely utilized.Currently,common approaches for endoscopic thyroid surgery include breast,oral vestibular,and transaxillary approach.Among them,endoscopic thyroidectomy by a gasless unilateral axillary approach has been highly recognized by many thyroid surgeons.This technique can meet patients'cosmetic needs while utilizing the natural space between neck muscles for operation to achieve the goal of minimally invasive surgery.Although the transaxillary gasless endoscopic thyroidectomy has become increasingly mature and standardized,several challenges need to be directly addressed in contralateral treatment of bilateral lobectomy during performing gasless unilateral axillary approach-endoscopic total thyroidectomy(GUA-ETT),such as avoiding tracheal obstruction,smoothly exposing the contralateral recurrent laryngeal nerve,and ensuring thorough clearance of contralateral central lymph nodes.In the authors'center,an improved three-step method for contralateral treatment and contralateral central lymph node dissection after unilateral thyroidectomy is proposed.To help thyroid surgeons master this technique,here,the authors provide a thorough explanation and sharing of the surgical methods,technical characteristics,operative techniques and nuances,as well as operative key points,difficulties,and operative experiences of the improved three-step method for contralateral treatment in GUA-ETT.