Objective: To retrospectively evaluate the feasibility and clinical value of video assisted endoscopic thyroidectomy by the breast approach. Methods: From December 2002 to May 2003, 28 patients with a mean age of 28 ...Objective: To retrospectively evaluate the feasibility and clinical value of video assisted endoscopic thyroidectomy by the breast approach. Methods: From December 2002 to May 2003, 28 patients with a mean age of 28 years (range from 20 to 45 years) were selected and given video assisted endoscopic thyroidectomy by the breast approach. The subcutaneous space in the breast area and the subplatysmal space in the neck were bluntly dissociated through a 10 mm incision between the nipples, and CO 2 was insufflated at 6 8 kban to create the operative space. Three trocars were inserted in the mammary regions, and dissection of the thyroid and division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results: Among the patients, 3 were mass resections, 17 subtotal lobectomies, 2 total lobectomies, and 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1±26.0) min; the mean estimated blood loss was (47.9±19.6) ml; and the mean postoperative hospital stay was (3.4±0.7) d. The drainage tubes were pulled out at 36 60 h postoperatively. There were no conversions to open surgery or complications. No scars left in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Video assisted endoscopic thyroidectomy using a breast approach and low pressure subcutaneous CO 2 insufflation is a feasible and safe procedure, which results in satisfactory appearance. We believe that video assisted endoscopic thyroidectomy by such approach will play a role in the future.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
Introduction: The aim of the study was to compare the feasibility and safety of endoscopic thyroid lobectomy via axillary-breast-shoulder approach (ET via ABS) with a conventional open thyroid lobectomy (OT). Methods:...Introduction: The aim of the study was to compare the feasibility and safety of endoscopic thyroid lobectomy via axillary-breast-shoulder approach (ET via ABS) with a conventional open thyroid lobectomy (OT). Methods: From November 2014 to December 2015, 20 patients with unilateral benign thyroid nodules were treated with ET via ABS and another 20 patients were treated with an OT. We analyzed the clinical characteristics postoperative complications, pain, and patient satisfaction. Results: No statistically significant differences occurred between groups except the mean ages of the OT group and the ET via ABS group were 55 and 44 years, respectively (p = 0.015). The mean operative time was almost the same in both groups (116 min in the OT group and 114 min in the ET via ABS group). Blood loss was significantly higher in the OT group than in the ET via ABS group (p = 0.042) but postoperative drainage was detected more in the ET via ABS group (p p = 0.026). The hospital stay was three days in OT group and four days in ET via ABS group (p = 0.909). Postoperative complications such as hematoma, hoarseness, dysphagia, and prolonged subcutaneous emphysema were detected only in the ET via ABS group but without statistical difference. More patients were “very satisfied” with the treatment in the ET via ABS group than in the OT group. Conclusion: The ET via ABS is as safe and effective as the OT for patients with unilateral thyroid nodules. With less early postoperative pain and higher patient satisfaction, this endoscopic thyroidectomy approach should be considered in patients who concern about cosmetic results.展开更多
文摘Objective: To retrospectively evaluate the feasibility and clinical value of video assisted endoscopic thyroidectomy by the breast approach. Methods: From December 2002 to May 2003, 28 patients with a mean age of 28 years (range from 20 to 45 years) were selected and given video assisted endoscopic thyroidectomy by the breast approach. The subcutaneous space in the breast area and the subplatysmal space in the neck were bluntly dissociated through a 10 mm incision between the nipples, and CO 2 was insufflated at 6 8 kban to create the operative space. Three trocars were inserted in the mammary regions, and dissection of the thyroid and division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results: Among the patients, 3 were mass resections, 17 subtotal lobectomies, 2 total lobectomies, and 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1±26.0) min; the mean estimated blood loss was (47.9±19.6) ml; and the mean postoperative hospital stay was (3.4±0.7) d. The drainage tubes were pulled out at 36 60 h postoperatively. There were no conversions to open surgery or complications. No scars left in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Video assisted endoscopic thyroidectomy using a breast approach and low pressure subcutaneous CO 2 insufflation is a feasible and safe procedure, which results in satisfactory appearance. We believe that video assisted endoscopic thyroidectomy by such approach will play a role in the future.
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.
文摘Introduction: The aim of the study was to compare the feasibility and safety of endoscopic thyroid lobectomy via axillary-breast-shoulder approach (ET via ABS) with a conventional open thyroid lobectomy (OT). Methods: From November 2014 to December 2015, 20 patients with unilateral benign thyroid nodules were treated with ET via ABS and another 20 patients were treated with an OT. We analyzed the clinical characteristics postoperative complications, pain, and patient satisfaction. Results: No statistically significant differences occurred between groups except the mean ages of the OT group and the ET via ABS group were 55 and 44 years, respectively (p = 0.015). The mean operative time was almost the same in both groups (116 min in the OT group and 114 min in the ET via ABS group). Blood loss was significantly higher in the OT group than in the ET via ABS group (p = 0.042) but postoperative drainage was detected more in the ET via ABS group (p p = 0.026). The hospital stay was three days in OT group and four days in ET via ABS group (p = 0.909). Postoperative complications such as hematoma, hoarseness, dysphagia, and prolonged subcutaneous emphysema were detected only in the ET via ABS group but without statistical difference. More patients were “very satisfied” with the treatment in the ET via ABS group than in the OT group. Conclusion: The ET via ABS is as safe and effective as the OT for patients with unilateral thyroid nodules. With less early postoperative pain and higher patient satisfaction, this endoscopic thyroidectomy approach should be considered in patients who concern about cosmetic results.
