Iorgulescu R, Badanoiu D, Lupu A, Cucu C, Niculescu D, Iordache N
Emergency Clinical Hospital "Sf. Ioan" Bucharest.
National Institute of Endocrinology "CI Parhon" Bucharest.
J Med Life. 2014;7 Spec No. 4(Spec Iss 4):54-61.
Precise and safe hemostasis is necessary for successful thyroid surgery. In this respect, the advent of the ultrasonic surgical device Harmonic Focus Curved Shears (HFCS) from Ethicon Endo-Surgery constituted a major progress in the domain by its multiple capabilities of dissection, grasping, vessel sealing and transecting. The paper presents the initial experience of 50 cases with this device of a surgical team with special interest in endocrine surgery, mostly thyroid and parathyroid. The thyroid conditions for which surgery was indicated were: diffuse toxic goiter in 8 patients; multinodular toxic and nontoxic goiter in 30 patients; autonomous nodule in 2 patients; 2 patients with benign nodules at fine needle aspiration biopsy (FNAB); 4 patients with nodules positive for carcinoma at FNAB, among them 2 with unilateral cervical lymph nodes enlargement; 4 patients with highly suspect nodule on FNAB. The types of surgery performed were 4 hemithyroidectomies and 46 total thyroidectomies, 2 in association with unilateral functional neck dissections. We had 4 intraoperative hemorrhagic incidents, all in the first 15 cases and imputable to lack of expertise and improper usage of the device. We registered the following noticeable postoperative complications: 1 cervical hematoma from an arteriolar source in sternothyroid muscle demanding prompt reintervention; 8 hypocalcemias and 2 vocal cord paresis, none of which permanent. We remarked several advantages with HFCS: no necessity of changing instruments, fluentness of the intervention and more comfort for the operating team, reduced operating time, safe hemostasis. Some important tips and tricks with the usage of the instrument are presented.
精确且安全的止血对于甲状腺手术的成功至关重要。在这方面，爱惜康内镜外科公司的超声手术设备谐波聚焦弯剪（HFCS）的出现，凭借其在解剖、抓取、血管封闭和横断方面的多种功能，在该领域取得了重大进展。本文介绍了一个对内分泌外科，主要是甲状腺和甲状旁腺特别感兴趣的手术团队使用该设备进行50例手术的初步经验。手术指征的甲状腺疾病包括：8例弥漫性毒性甲状腺肿；30例多结节毒性和非毒性甲状腺肿；2例自主性结节；2例细针穿刺活检（FNAB）显示良性结节的患者；4例FNAB显示癌阳性的结节患者，其中2例伴有单侧颈部淋巴结肿大；4例FNAB显示高度可疑结节的患者。所进行的手术类型为4例半甲状腺切除术和46例全甲状腺切除术，其中2例联合单侧功能性颈清扫术。我们有4例术中出血事件，均发生在前15例病例中，原因是缺乏专业知识和设备使用不当。我们记录了以下明显的术后并发症：1例源于胸骨甲状肌小动脉的颈部血肿，需要立即再次干预；8例低钙血症和2例声带麻痹，均非永久性。我们注意到HFCS有几个优点：无需更换器械、手术操作流畅且手术团队更舒适、手术时间缩短、止血安全。文中还介绍了一些使用该器械的重要技巧。
