Yeh T S, Jan Y Y, Hsu B R, Chen K W, Chen M F
Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taipei, Taiwan.
Am J Surg. 2000 Aug;180(2):82-5. doi: 10.1016/s0002-9610(00)00429-3.
Several experimental and clinical reports concerning endoscopic parathyroid surgery have appeared. However, reports concerning minimally invasive surgery for thyroid remains rare. Herein we present a new method, called video-assisted endoscopic thyroidectomy (VAET), for the management of various benign thyroid diseases.
In all, 16 consecutive patients who underwent VAET for benign thyroid diseases were retrospectively studied. The study group included nodular hyperplasia in 8 patients, follicular adenoma in 6, and Hurthle's tumor and simple cyst in 1 each. A 2 to 3 cm transverse incision was made on the suprasternal notch. The wound was deepened to expose the underlying trachea from which the plane of the thyroid fascia was accessed directly, and the working space was established with lifting method using conventional instrument. All surgical procedures could be manipulated and monitored under laparoscopy without gas insufflation. The ultrasonically activated scalpel was the principal instrument used for VAET.
All 16 patients underwent VAET successfully without conversion to open thyroidectomy. The surgical procedures included lobectomy in 13 and extirpation in 3. The operation time ranged from 28 minutes to 5 hours (mean 1 hour, 42 minutes). For the 5 most recent cases, lobectomy took an average of 2 hours, whereas extirpation less than 40 minutes. The tumor size ranged from 3.5 cm to 8.0 cm (mean 5.8 cm). There were no surgical complications. All patients but 1 were discharged on postoperative day 2. During follow-up, all patients demonstrated euthyroid function and satisfactory cosmetic results.
VAET emerges as a promising minimally invasive surgical technique replacing conventional thyroidectomy for benign thyroid diseases in selected cases, with the advantage of satisfactory cosmetic results.
有关内镜甲状旁腺手术的多项实验和临床报告已经出现。然而，关于甲状腺微创手术的报告仍然很少。在此，我们介绍一种称为视频辅助内镜甲状腺切除术（VAET）的新方法，用于治疗各种良性甲状腺疾病。
对16例连续接受VAET治疗良性甲状腺疾病的患者进行回顾性研究。研究组包括8例结节性增生、6例滤泡性腺瘤、1例许特耳氏肿瘤和1例单纯囊肿。在胸骨上切迹处做一个2至3厘米的横向切口。将伤口加深以暴露下方的气管，直接从此处进入甲状腺筋膜平面，并使用传统器械通过提拉法建立工作空间。所有手术操作均可在无气腹的腹腔镜下进行操作和监测。超声刀是VAET使用的主要器械。
所有16例患者均成功接受VAET，无需转为开放性甲状腺切除术。手术方式包括13例叶切除术和3例摘除术。手术时间从28分钟到5小时不等（平均1小时42分钟）。对于最近的5例病例，叶切除术平均耗时2小时，而摘除术不到40分钟。肿瘤大小从3.5厘米到8.0厘米不等（平均5.8厘米）。无手术并发症。除1例患者外，所有患者均在术后第2天出院。在随访期间，所有患者甲状腺功能正常，美容效果满意。
VAET作为一种有前景的微创手术技术，在特定病例中可替代传统甲状腺切除术治疗良性甲状腺疾病，具有美容效果满意的优点。
