Wilhelm T, Harlaar J, Kerver A, Kleinrensink G-J, Benhidjeb T
Klinik für HNO-Heilkunde, Kopf-/Hals- und plastische Gesichtschirurgie, HELIOS Klinikum Borna, Borna, Deutschland.
Chirurg. 2010 Jan;81(1):50-5. doi: 10.1007/s00104-009-1823-8.
Surgical access trauma in thyroidectomy has been minimized by the adoption of minimally invasive techniques. Extracervical approaches moved the incision lines outside of the visible neck region. However, because of the extensive dissection they no longer comply with the term minimally invasive. Therefore, our goal was to reduce the access trauma and establish a non-traumatic approach according to surgical planes for endoscopic minimally invasive thyroidectomy: the transoral approach.
In a preclinical investigation anatomical dissection was performed on three human cadavers to visualize anatomical relationships and identify safe zones of access to the anterior neck and the submandibular regions. The investigation focused on relevant vascular and neural structures in the floor of mouth. Endoscopic minimally invasive thyroidectomy was additionally performed in five specimens with anatomical dissections for the evaluation of collateral damage.
For a safe approach the optic trocar can be placed sublingually in the midline as there are no relevant vascular or neural structures on the way to the thyroid region. The working trocars can be placed bilaterally in the oral vestibule behind the canine teeth. In this way access and dissection plane are placed directly in an avascular subplatysmal area and the pretracheal working space can be reached easily, safe and fast.
Minimum impact and a gentle dissection according to anatomical planes are the rational for the transoral route to the thyroid gland. Thus based on anatomical dissections the foundations of a novel procedure in the context of natural orifice surgery (NOS) could be established.
通过采用微创技术，甲状腺切除术中的手术入路创伤已降至最低。颈外入路将切口线移至可见颈部区域之外。然而，由于广泛的解剖操作，它们不再符合微创的定义。因此，我们的目标是减少入路创伤，并根据手术平面建立一种用于内镜微创甲状腺切除术的无创入路：经口入路。
在一项临床前研究中，对三具人体尸体进行了解剖，以观察解剖关系并确定进入颈前部和下颌下区域的安全区域。研究重点关注口底的相关血管和神经结构。另外，在五个标本上进行了解剖并实施了内镜微创甲状腺切除术，以评估附带损伤。
为了实现安全入路，由于在通向甲状腺区域的途中没有相关血管或神经结构，可视套管针可舌下置于中线位置。工作套管针可双侧置于尖牙后方的口腔前庭。通过这种方式，入路和解剖平面直接位于无血管的颈阔肌下区域，可轻松、安全且快速地到达气管前工作空间。
最小的影响和根据解剖平面进行轻柔解剖是经口途径到达甲状腺的理论依据。因此，基于解剖学研究，可以建立自然腔道手术（NOS）背景下一种新手术方法的基础。
