Department Otolaryngology, Head, Neck and Facial Plastic Surgery, HELIOS Kliniken Leipziger Land, Rudolf-Virchow-Str. 2, 04552 Borna, Germany.
Eur Arch Otorhinolaryngol. 2010 Aug;267(8):1285-90. doi: 10.1007/s00405-010-1219-x. Epub 2010 Feb 24.
Over the past 10 years, several minimally invasive procedures for thyroid surgery have been developed. Because of extensive dissection in the thoracic and neck region, the name "minimal-invasive" is misleading. The aim of this study was to define a new trans-oral access to the cervical spaces especially to the thyroid on the basis of natural orifice surgery. Three embalmed human specimens were dissected for complete review of the anatomical situation in the cervical region. In additional five fresh frozen human specimens after an experimental trans-oral endoscopic minimally invasive thyroidectomy the anatomical structures of the floor of the oral cavity as well as the anterior neck region were evaluated. It was possible to create a working space under the platysma muscle with respect to the surgical planes of the neck and fascial layers. Within this area, the pretracheal region can be reached and the thyroid gland can be visualized and resected. To access the working space, a trocar for endoscopic view is placed medially in the floor of the oral cavity sublingually. The trocar passes the muscles of the floor of the oral cavity easily without relation to relevant anatomical structures. A first exclusively sublingual approach had to be abandoned because triangulation of the instruments could not be reached. Therefore, the approach was modified by positioning the working trocars in the oral vestibule bilaterally. By this way, a road map for accessing all anterior cervical regions directly under the platysma muscle could be established and anatomical landmarks and areas of possible collateral damage could have been defined. This combined sublingual and bi-vestibular trans-oral endoscopic approach enables an easy access to all structures and spaces of the anterior neck region with respect to anatomical preformed layers neck, even to the thyroid as one of the more distant structures.
在过去的 10 年中，已经开发出了几种用于甲状腺手术的微创程序。由于在胸部和颈部区域进行了广泛的解剖，因此“微创”这个名称具有误导性。本研究的目的是基于经自然腔道手术为颈部的特别是甲状腺提供新的经口入路。对三个防腐的人体标本进行了解剖，以全面检查颈部区域的解剖情况。在另外五个新鲜冷冻的人体标本上进行了经口内镜微创甲状腺切除术后，评估了口腔底部和前颈部区域的解剖结构。可以在颈筋膜和肌肉平面下创建一个在颈阔肌下的工作空间。在这个区域内，可以到达气管前区域，并可以可视化和切除甲状腺。为了进入工作空间，经口内镜视图的套管针放置在口腔底部的中线位置，位于舌下。套管针很容易穿过口腔底部的肌肉，而与相关的解剖结构无关。由于无法达到器械的三角关系，我们不得不放弃最初的完全舌下入路。因此，我们通过将工作套管针分别放置在口腔前庭双侧来对入路进行修改。通过这种方式，可以建立一个直接在颈阔肌下到达所有前颈区域的路线图，并确定解剖学标志和可能的并发损伤区域。这种舌下和双侧经口内镜联合入路可以轻松地进入前颈部区域的所有结构和空间，包括甲状腺等较远处的结构，而这些都与颈部的解剖预成型层有关。
