Nenkov R, Radev R, Madjov R, Ignatov I
Khirurgiia (Sofiia). 2008(3):32-5.
The harmonic scalpel has been widely used in the field of thyroid surgery in recent years.
To present our initial results after the introduction of harmonic scalpel use during thyroid resections with minimally invasive open approach.
For the period from 01 January to 31 June 2008, 158 thyroid resections using harmonic scalpel have been done in our institution. In 73 of these procedures minimally invasive open approach has been used (69 females and 4 males, at the age of 18 to 54 years, mean age 34.3 years). Patients have been directed to the group with minimally invasive open approach on the ground of inclusion criteria and indications for minimally invasive surgery adopted in our institution. The size of the dominant nodule in multinodular goiters was less than 3.5 cm. In 38 (52%) patients with suspicious malignancy FNAB has been performed. In all procedures a central neck operative approach has been used with length of the incision between 2 and 3 cm (measured in the beginning and at the end of the procedure as well as on the 4th postoperative day). Thyroid resections have been performed using harmonic scalpel (Ethicon Inc.). The extent of thyroid resection, the amount of hemostatic instruments and ligatures, the number of drainages used during the procedures, as well as operative time and incidence of intra- and postoperative complications have been examined.
In 8 patients subtotal unilateral thyroid resections have been performed, 42 patients underwent lobectomy, 5 patients--subtotal bilateral thyroid resection and 18 patients--thyroidectomy. The extent of surgery was: isthmusectomy with unilateral partial thyroid resection in 11 patients, isthmusectomy with bilateral partial thyroid resection in 8 patients, isthmusectomy with subtotal unilateral thyroid resection in 29 patients, lobectomy in 24 patients, subtotal bilateral thyroid resection in 17 patients and thyroidectomy in 18 patients. No hemostatic instruments for catching thyroid tissue and vessels, nor following suture ligatures have been used. Incision length reduction, absence of bleeding and shortened operative time have been observed. The reliable and steady hemostasis made the use of hemostatic instruments and stitches unnecessary. Regardless of the extent of surgery, the resections finished without draining.
We have found the harmonic scalpel to be extremely effective device, giving possibility for widespread of minimally invasive thyroid resections with open approach.
近年来，超声刀已在甲状腺手术领域广泛应用。
介绍我们在采用微创开放入路的甲状腺切除术中引入超声刀后的初步结果。
在2008年1月1日至6月31日期间，我们机构使用超声刀进行了158例甲状腺切除术。其中73例采用了微创开放入路（69例女性，4例男性，年龄18至54岁，平均年龄34.3岁）。根据我们机构采用的微创外科手术纳入标准和适应证，将患者纳入微创开放入路组。多结节性甲状腺肿中优势结节的大小小于3.5 cm。38例（52%）可疑恶性肿瘤的患者进行了细针穿刺抽吸活检（FNAB）。所有手术均采用颈部中央手术入路，切口长度在2至3 cm之间（在手术开始、结束时以及术后第4天测量）。使用超声刀（爱惜康公司）进行甲状腺切除术。检查了甲状腺切除范围、止血器械和结扎线的使用量、手术过程中使用引流管的数量、手术时间以及术中及术后并发症的发生率。
8例患者进行了单侧甲状腺次全切除术，42例患者接受了甲状腺叶切除术，5例患者进行了双侧甲状腺次全切除术，18例患者进行了甲状腺全切除术。手术范围为：11例患者行峡部切除加单侧部分甲状腺切除术，8例患者行峡部切除加双侧部分甲状腺切除术，29例患者行峡部切除加单侧甲状腺次全切除术，24例患者行甲状腺叶切除术，17例患者行双侧甲状腺次全切除术，18例患者行甲状腺全切除术。未使用用于抓取甲状腺组织和血管的止血器械，也未进行后续缝合结扎。观察到切口长度缩短、无出血且手术时间缩短。可靠且稳定的止血使得无需使用止血器械和缝线。无论手术范围如何，切除术后均无需引流。
我们发现超声刀是一种极其有效的器械，为广泛开展开放入路的微创甲状腺切除术提供了可能。
