BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyro...BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyroidectomy is very low,it is potentially fatal.The clinical manifestations of CDE vary,and more attention should be paid to this disorder.CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach.The patient had no other diseases or surgical history.During the operation,he developed a CDE following inadvertent injury of the anterior jugular vein.The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide,and his remaining vital signs were stable.In addition,loud coarse systolic and diastolic murmurs were heard over the precordium.The patient was discharged on day 4 after surgery without complications.CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.展开更多
目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌...目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。展开更多
Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instru...Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instruments and an extra one for the endoscopic camera,or using three robot arms for instruments(third arm through axila)and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue.The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation.Ultimately,these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar.Another issue to consider is the cost.In some places,robotic surgery operation fee varies with the number of arms used during the operation.Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.展开更多
基金Science and Technology Bureau of Shapingba District,Chongqing,China,No.JCD202041and Science and Technology Bureau of Chongqing,China,No.CSTC2019JXJL130029.
文摘BACKGROUND Endoscopic thyroidectomy has obvious advantages over conventional surgical techniques in terms of postoperative cosmetic outcome.Although the incidence of carbon dioxide embolism(CDE)during endoscopic thyroidectomy is very low,it is potentially fatal.The clinical manifestations of CDE vary,and more attention should be paid to this disorder.CASE SUMMARY A 27-year-old man was scheduled for thyroidectomy by the transoral vestibular approach.The patient had no other diseases or surgical history.During the operation,he developed a CDE following inadvertent injury of the anterior jugular vein.The clinical manifestation in this patient was a transient sharp rise in end-tidal carbon dioxide,and his remaining vital signs were stable.In addition,loud coarse systolic and diastolic murmurs were heard over the precordium.The patient was discharged on day 4 after surgery without complications.CONCLUSION A transient sharp rise in end-tidal carbon dioxide is considered a helpful early sign of CDE during endoscopic thyroidectomy.
文摘目的探讨经口腔前庭入路腔镜甲状腺切除术(endoscopic thyroidectomy using the oral vestibular approach,ETOVA)与传统颈部开放手术治疗女性甲状腺乳头状癌的安全性、有效性及美容效果。方法回顾性分析2019年1~12月行甲状腺乳头状癌根治术的120例女性患者的临床资料,分为经口腔前庭入路腔镜甲状腺手术组(腔镜组,n=60)和传统颈部开放手术组(开放组,n=60),对比两组患者术中及术后相关临床资料。结果两组患者年龄、肿瘤直径、中央区淋巴结清扫时间、中央区淋巴结清扫总数、中央区转移淋巴结数量、术后并发症、术后24 h疼痛评分、术后6个月疼痛评分均无统计学差异(P均>0.05)腔镜组手术总时长、术中失血量、术后引流量均大于开放组(P均<0.001),腔镜组术后满意度高。结论ETOVA在治疗甲状腺乳头状癌是安全、有效的,具有更好的美容效果,患者满意度高,可以考虑作为部分患者,尤其是年轻女性甲状腺乳头状癌患者的首选手术方案。
文摘Background:Transoral vestibular approach thyroidectomy using robotic system has advantages with articulating instrumentation.Transoral robotic thyroidectomy(TORT)can be done either using just two robot arms for instruments and an extra one for the endoscopic camera,or using three robot arms for instruments(third arm through axila)and an additional arm for the camera.Pros of additional axillary arm for TORT:The 4th arm through an additional axillary port is mainly responsible for a counter-traction of strap muscles and thyroid tissue.The additional axillary port tract is also an excellent passage for the specimen removal with lower risk of disruption or fragmentation.Ultimately,these merits from the additional axillary arm allows TORT to be performed safely in a wide range of patient groups.Cons of additional axillary arm for TORT:One of the issue with the additional axillary arm in TORT is that it leaves a cutaneous scar.Another issue to consider is the cost.In some places,robotic surgery operation fee varies with the number of arms used during the operation.Retraction of strap muscles through subcutaneous stitches applied after establishing the working space may make up for the lack of counter-traction.Conclusion:TORT can be done safely with or without the transaxillary arm and surgeon may consider pros and cons based on multiple factors.
