Puntambekar Shailesh P, Palep Reshma J, Patil Anjali M, Rayate Neeraj V, Joshi Saurabh N, Agarwal Geetanjali A, Joshi Milind
Galaxy Laparoscopy Institute, 25-A, Karve Road, Near Garware College, Pune - 411 004, India.
J Minim Access Surg. 2007 Jul;3(3):91-7. doi: 10.4103/0972-9941.37191.
Minimally invasive surgery is widely employed for the treatment of thyroid diseases. Several minimal access approaches to the thyroid gland have been described. The commonly performed surgeries have been endoscopic lobectomies. We have performed endoscopic total thyroidectomy by the anterior chest wall approach. In this study, we have described our technique and evaluated the feasibility and efficacy of this procedure.
From June 2005 to August 2006, 15 cases of endoscopic thyroidectomy were done at our institute. Five patients were male and 10 were female. Mean age was 45 years. (Range 23 to 71 years). Four patients had multinodular goiter and underwent near-total thyroidectomy; four patients had follicular adenoma and underwent hemithyroidectomy. Out of the seven patients of papillary carcinoma, four were low-risk and so a hemithyroidectomy was performed while three patients in the high risk group underwent total thyroidectomy. A detailed description of the surgical technique is provided.
The mean nodule size was 48 mm (range 20-80 mm) and the mean operating time was 85 min (range 60-120 min). In all cases, the recurrent laryngeal nerve was identified and preserved intact, the superior and inferior parathyroids were also identified in all patients. No patients required conversion to an open cervicotomy. All patients were discharged the day after surgery. All thyroidectomies were completed successfully. No recurrent laryngeal nerve palsies or postoperative tetany occurred. The postoperative course was significantly less painful and all patients were satisfied with the cosmetic results.
It is possible to remove large nodules and perform as well as total thyroidectomies using our endoscopic approach. It is a safe and effective technique in the hands of an appropriately trained surgeon. The patients get a cosmetic benefit without any morbidity.
微创手术广泛应用于甲状腺疾病的治疗。已经描述了几种进入甲状腺的微创方法。常见的手术是内镜下甲状腺叶切除术。我们采用前胸壁入路进行了内镜下全甲状腺切除术。在本研究中，我们描述了我们的技术，并评估了该手术的可行性和有效性。
2005年6月至2006年8月，我院共进行了15例内镜下甲状腺切除术。男性5例，女性10例。平均年龄45岁（范围23至71岁）。4例患者患有结节性甲状腺肿，接受了近全甲状腺切除术；4例患者患有滤泡性腺瘤，接受了甲状腺半切除术。在7例乳头状癌患者中，4例为低风险，因此进行了甲状腺半切除术，而3例高风险组患者接受了全甲状腺切除术。提供了手术技术的详细描述。
平均结节大小为48毫米（范围20 - 80毫米），平均手术时间为85分钟（范围60 - 120分钟）。所有病例均识别并完整保留了喉返神经，所有患者也识别了甲状旁腺上、下极。无一例患者需要转为开放性颈部切开术。所有患者术后次日出院。所有甲状腺切除术均成功完成。未发生喉返神经麻痹或术后手足抽搐。术后疼痛明显减轻，所有患者对美容效果满意。
使用我们的内镜方法可以切除大结节并进行全甲状腺切除术。在经过适当培训的外科医生手中，这是一种安全有效的技术。患者获得了美容益处且无任何并发症。
