Department of General, Visceral and Vascular Surgery, Agatharied Academic Teaching Hospital, Ludwig-Maximilians-University Munich, Norbert-Kerkel-Platz 1, Hausham/Oberbayern, 83734, Munich, Germany.
World J Surg. 2010 Dec;34(12):2997-3006. doi: 10.1007/s00268-010-0769-9.
The aim of the present study was to test the safety and feasibility of the dorsal approach endoscopic thyroidectomy procedure in a prospective trial in humans, after the procedure had been developed ex vivo in human cadavers.
A total of 28 patients were enrolled for 30 unilateral procedures of thyroidectomy. Two cases were staged bilateral procedures. Patients presenting with suspicious cold nodules, hot nodules, or goiters were operated on under general anaesthesia. Skin incision is carried out on the scalp, behind the ear. Deep to the sternocleidomastoid muscle, but respecting the superficial cervical fascia, the preparation goes past the carotid triangle to reach the thyroid below the straight neck muscles. Postoperatively the patients underwent neurological assessment, vocal cord examination, clinical control for hemorrhage, and determination of serum levels of Ca(2+).
Thirty unilateral procedures by the dorsal approach were carried out in 22 women and 6 men. There was 1 subtotal thyroidectomy and 29 total unilateral thyroidectomies with no conversions. There was one permanent recurrent laryngeal nerve (RLN) lesion and one postoperative hemorrhage. The size of the lobes removed ranged from 6 to 40 ml (mean: 18 ml). In four cases the specimen exceeded 38 ml. There was one multifocal papillary cancer requiring open surgical revision and lymphadenectomy. The other diagnoses were benign. All wounds healed by primary intention. Temporary impairment of cervical nerves was detected in six patients. It was possible to avoid access-related problems by improving the patient's positioning on the operating table, omitting straight instruments, and respecting the superficial fascia before entering the carotid triangle.
Hemithyroidectomy by the dorsal approach is feasible. It is a single surgeon, single port, gasless unilateral endoscopic technique with the option to go bilateral.
本研究旨在通过在人体尸体上进行的体外研究后，在人体前瞻性试验中测试经皮内镜甲状腺切除术的安全性和可行性。
共有 28 例患者入组进行 30 例单侧甲状腺切除术。其中 2 例分期双侧手术。对怀疑冷结节、热结节或甲状腺肿的患者在全身麻醉下进行手术。头皮后，耳后行皮肤切口。在胸锁乳突肌深面，但在浅颈筋膜深面，准备越过颈动脉三角到达直颈肌下方的甲状腺。术后患者接受神经学评估、声带检查、出血临床检查和血清 Ca(2+)水平测定。
22 名女性和 6 名男性进行了 30 例单侧经皮内镜甲状腺切除术。其中 1 例甲状腺次全切除术和 29 例单侧甲状腺全切除术，无中转手术。有 1 例永久性喉返神经（RLN）损伤和 1 例术后出血。切除的腺叶大小从 6 至 40ml（平均 18ml）不等。在 4 例中，标本超过 38ml。有 1 例多灶性乳头状癌需行开放性手术修正和淋巴结清扫术。其他诊断为良性。所有伤口均一期愈合。6 例患者发现颈神经暂时受损。通过改善患者在手术台上的体位、避免使用直器械以及在进入颈动脉三角前保护浅筋膜，可以避免与入路相关的问题。
经皮内镜甲状腺切除术是可行的。它是一种由单一术者进行的、单端口的、非气腹的、单侧内镜技术，可双侧操作。
