Berber Eren, Bernet Victor, Fahey Thomas J, Kebebew Electron, Shaha Ashok, Stack Brendan C, Stang Michael, Steward David L, Terris David J
1 Department of Endocrine Surgery, Cleveland Clinic , Cleveland, Ohio.
2 Division of Endocrinology, Mayo Clinic , Jacksonville, Florida.
Thyroid. 2016 Mar;26(3):331-7. doi: 10.1089/thy.2015.0407.
Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption.
A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery.
Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillo-breast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision.
Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.
近年来，远程接入技术已被描述为一种无需颈部切口即可切除甲状腺的方法。然而，对于可用技术的数量以及给定技术的理想患者选择标准存在混淆。本综述的目的是对这些方法进行简单分类，描述最佳患者选择标准，客观评估结果，并确定采用的障碍。
对文献进行综述以确定所描述的技术。制定了一个简单的分类。描述了技术细节、结果和学习曲线。就远程接入甲状腺手术的患者选择和操作建议形成了专家意见共识。
远程接入甲状腺手术可分为内镜或机器人乳房入路、双侧腋窝 - 乳房入路、腋窝入路和面部提升入路。美国的经验涉及后两种技术。文献中的有限数据表明，与传统甲状腺切除术相比，远程接入甲状腺手术的手术时间长、学习曲线陡峭且成本更高。然而，已达成共识，在合适的人手中，对于希望避免颈部切口的单侧小结节患者，它可以是一种可行的选择。
远程接入甲状腺切除术在符合严格选择标准的一小部分患者中具有作用。这些方法需要更高水平的专业知识，因此应由大量开展甲状腺和机器人手术的外科医生进行。
