Chen Dawei, Ding Kebao, Guo Kai, Hong Hai
Department of General Surgery, Soong Ching Ling Grace Hospital, Chao Hu, China.
JSLS. 2012 Jan-Mar;16(1):60-4. doi: 10.4293/108680812X13291597715989.
Endoscopic thyroidectomy making the scar outside the neck area has a cosmetic appeal for patients. Based on an anterior chest wall approach combined with the gasless technique, we developed a novel method for gasless endoscopic thyroidectomy with a single incision.
From March 2009 to November 2010, 48 patients with benign thyroid nodules underwent thyroidectomy with the gasless single-incision endoscopic surgery technique via the anterior chest wall approach. A 3-cm long skin incision parallel to the clavicle was made on the anterior chest wall on the side of the lesion. The platysma flap was lifted up to maintain working space from the incision to the thyroid cartilage. Dissection of the thyroid was begun from the inferior pole of the thyroid. The line of resection was selected to preserve recurrent laryngeal nerve and parathyroids. A 5-mm drainage tube was inserted into the lower portion of the operative space through the incision after the thyroid gland and the lesion were resected using the Harmonic scalpel.
The overall operating time was 126 minutes (range, 90 to 210), 138 minutes (range, 80 to 160) in first 24 cases; and 112 minutes in the second 24 patients (P<.05). Three cases were converted to the conventional procedure: 2 because of a malignancy diagnosed on frozen section, and one due to uncontrolled bleeding from the middle thyroid vein. Another malignancy diagnosed on final pathological examination was treated with additional surgery to complete the thyroidectomy by using the conventional open method. There were 2 cases of postoperative complications: transient hoarseness and hematoma. No wound infection occurred in our series. The scar was well hidden beneath the clothes, and the patients were satisfied with the cosmetic result of the surgery.
Advantages of the chest wall approach combined with the gasless technique have made singleincision endoscopic thyroidectomy more feasible and practicable.
内镜甲状腺切除术在颈部区域外形成瘢痕，对患者具有美容吸引力。基于前胸壁入路结合免气腹技术，我们开发了一种单切口免气腹内镜甲状腺切除术的新方法。
2009年3月至2010年11月，48例甲状腺良性结节患者通过前胸壁入路采用免气腹单切口内镜手术技术进行甲状腺切除术。在病变侧的前胸壁做一个与锁骨平行的3厘米长的皮肤切口。提起颈阔肌皮瓣以维持从切口到甲状软骨的工作空间。从甲状腺下极开始解剖甲状腺。选择切除线以保留喉返神经和甲状旁腺。使用超声刀切除甲状腺和病变后，通过切口将一根5毫米的引流管插入手术空间下部。
总手术时间为126分钟（范围90至210分钟），前24例为138分钟（范围80至160分钟）；后24例为112分钟（P<0.05）。3例转为传统手术：2例因冰冻切片诊断为恶性肿瘤，1例因甲状腺中静脉出血无法控制。最终病理检查诊断出的另一例恶性肿瘤通过额外手术采用传统开放方法完成甲状腺切除术。术后有2例并发症：短暂性声音嘶哑和血肿。我们的系列中未发生伤口感染。瘢痕很好地隐藏在衣服下面，患者对手术的美容效果满意。
胸壁入路结合免气腹技术的优点使单切口内镜甲状腺切除术更可行、更实用。
