Al Kadah Basel, Piccoli Micaela, Mullineris Barbara, Colli Giovanni, Janssen Martin, Siemer Stephan, Schick Bernhard
Department of Otorhinolaryngology, University Medical Center, Kirrberger Straße, 66421, Homburg, Saar, Germany.
Department of General Surgery, New Sant'Agostino Hospital, Modena, Italy.
J Robot Surg. 2015 Mar;9(1):37-44. doi: 10.1007/s11701-014-0486-8. Epub 2014 Sep 2.
Endoscopic surgery for treatment of thyroid and parathyroid pathologies is increasingly gaining attention. The da Vinci system has already been widely used in different fields of medicine and quite recently in thyroid and parathyroid surgery. Herein, we report about modifications of the transaxillary approach in endoscopic surgery of thyroid and parathyroid gland pathologies using the da Vinci system. 16 patients suffering from struma nodosa in 14 cases and parathyroid adenomas in two cases were treated using the da Vinci system at the ENT Department of Homburg/Saar University and in cooperation with the Department of General Surgery in New Sant'Agostino Hospital, Modena/Italy. Two different retractors, endoscopic preparation of the access and three different incision modalities were used. The endoscopic preparation of the access allowed us to have a better view during preparation and reduced surgical time compared to the use of a headlamp. To introduce the da Vinci instruments at the end of the access preparation, the skin incisions were over the axilla with one incision in eight patients, two incisions in four patients and three incisions in a further four patients. The two and three skin incisions modality allowed introduction of the da Vinci instruments without arm conflicts. The use of a new retractor (Modena retractor) compared to a self-developed retractor made it easier during the endoscopic preparation of the access and the reposition of the retractor. The scar was hidden in the axilla and independent of the incisions selected, the cosmetic findings were judged by the patients to be excellent. The neurovascular structures such as inferior laryngeal nerve, superior laryngeal nerve and vessels, as well as the different pathologies, were clearly 3D visualized in all 16 cases. No paralysis of the vocal cord was observed. All patients had a benign pathology in their histological examination. The endoscopic surgery of the thyroid and parathyroid gland can be performed using the da Vinci system and offers an excellent, intra-operative, 3D visualization of the neurovascular structures. The new incision modalities, use of a new retractor, and endoscopic preparation of the access made the surgery easier and safer using the transaxillary access to the thyroid and parathyroid glands. The modified skin incisions allowed an improved movement of the da Vinci arms during operation.
内镜手术治疗甲状腺和甲状旁腺疾病越来越受到关注。达芬奇系统已在医学的不同领域广泛应用，最近也应用于甲状腺和甲状旁腺手术。在此，我们报告使用达芬奇系统对甲状腺和甲状旁腺疾病进行内镜手术时经腋窝入路的改良方法。在萨尔州洪堡大学耳鼻喉科，并与意大利摩德纳新圣阿戈斯蒂诺医院普通外科合作，使用达芬奇系统治疗了16例患者，其中14例为结节性甲状腺肿，2例为甲状旁腺腺瘤。使用了两种不同的牵开器、内镜下通道准备以及三种不同的切口方式。与使用头灯相比，内镜下通道准备使我们在准备过程中有更好的视野并缩短了手术时间。为了在通道准备结束时引入达芬奇器械，8例患者在腋窝上方做一个切口，4例患者做两个切口，另外4例患者做三个切口。两个和三个皮肤切口方式允许在不发生器械臂冲突的情况下引入达芬奇器械。与自行研制的牵开器相比，使用新型牵开器（摩德纳牵开器）使内镜下通道准备和牵开器重新定位更加容易。瘢痕隐藏在腋窝内，无论选择何种切口，患者对美容效果的评价均为极佳。在所有16例病例中，喉返神经、喉上神经和血管等神经血管结构以及不同的病变均能清晰地三维可视化。未观察到声带麻痹。所有患者的组织学检查均为良性病变。使用达芬奇系统可进行甲状腺和甲状旁腺的内镜手术，并能在术中对神经血管结构进行出色的三维可视化。新的切口方式、新型牵开器的使用以及内镜下通道准备，使得经腋窝入路进行甲状腺和甲状旁腺手术更加简便和安全。改良后的皮肤切口使达芬奇器械在手术过程中的活动更加灵活。
