Department of General, Digestive and Endocrine Surgery, Hospital Brabois-Adults, CHU Nancy, University of Nancy, 11, allée du Morvan, 54511 Vandœuvre-les-Nancy, France.
J Visc Surg. 2010 Dec;147(6):e399-402. doi: 10.1016/j.jviscsurg.2010.10.005. Epub 2010 Nov 20.
In head and neck surgery, minimally invasive approaches have been typically avoided due to concerns about visualization, possible damage to vital structures, and limited availability of effective instrumentation. The incorporation of robotic technology in surgery is now an accepted fact, and because of the complexities of certain laparoscopic procedures, the extended capabilities offered by robotic technology have gained wide acceptance. We report the case of a patient who underwent a robotic total thyroidectomy using a gasless right transaxillary approach. This technique provides a high quality image leading to improved visualization of vital structures during thyroidectomy with the added advantage of avoidance of a neck incision. Several issues regarding this technique remain to be clarified and evaluated in multicenter studies: patient selection, surgeon training and learning curve, postoperative morbidity due to recurrent nerve and parathyroid injury, long term oncologic and cosmetic results. However, we believe that robotic thyroid surgery using a gasless transaxillary approach will advance the frontiers of minimally invasive endocrine surgery.
在头颈部外科手术中，由于对可视化、对重要结构可能造成的损伤以及有效器械的缺乏等问题的担忧，微创手术方法通常被回避。机器人技术在外科手术中的应用现在已被广泛接受，并且由于某些腹腔镜手术的复杂性，机器人技术提供的扩展功能已被广泛接受。我们报告了一例使用无气右侧经腋入路进行机器人全甲状腺切除术的患者。该技术提供了高质量的图像，在甲状腺切除术中改善了对重要结构的可视化，并且避免了颈部切口。关于这项技术，还有几个问题需要在多中心研究中加以阐明和评估：患者选择、外科医生培训和学习曲线、由于喉返神经和甲状旁腺损伤引起的术后发病率、长期的肿瘤学和美容效果。然而，我们相信使用无气经腋入路的机器人甲状腺手术将推动微创内分泌手术的前沿。
