Sivakumar T, Amizhthu R A
Associate Professor in Fellowship of Minimal Access Surgey, Siva Hospital, Institute of Minimal Access Surgery, Kanyakumari, Tamil Nadu, India.
J Minim Access Surg. 2018 Apr-Jun;14(2):118-123. doi: 10.4103/jmas.JMAS_3_17.
Conventional open thyroidectomy is often associated with post-operative complications including nerve damage, voice disturbances, paraesthesias, adhesions and prominent scarring. Several endoscopic surgical techniques have been reported as alternatives to conventional thyroidectomy. Natural orifice transluminal endoscopic surgery is a promising approach which leaves no scar, produces few complications and affords faster discharge from care. Several studies have explored its utility in total thyroidectomy in patients with benign or malignant thyroid disease. Herein, we present a case series on the successful application of transoral endoscopic total thyroidectomy vestibular approach (TOETVA) in benign and malignant diseases of the thyroid. We performed TOETVA in 11 patients presenting with benign or malignant thyroid nodules in our hospital, between 1 January 2015 and 30 June 2016. The surgery was completed successfully in all patients with a pre-operative diagnosis of multinodular goitre. The surgery was performed under general anaesthesia and the mean operative time was 130 min. The mean blood loss was 2-3 cc. No incidence of recurrent laryngeal nerve injury, damage to mental nerve, parathyroid damage or peri-incisional adhesion occurred in the study participants. No visible scarring occurred in the patients following surgery. The patients had an uneventful recovery after the surgery and were discharged after 4 days. TOETVA is safe and effective in the surgical management of multinodular goitre and offers a scar-free alternative to conventional surgery.
传统开放性甲状腺切除术常伴有术后并发症，包括神经损伤、声音障碍、感觉异常、粘连和明显瘢痕形成。已有多种内镜手术技术被报道可作为传统甲状腺切除术的替代方法。经自然腔道内镜手术是一种很有前景的方法，不留瘢痕，并发症少，出院快。多项研究探讨了其在良性或恶性甲状腺疾病患者全甲状腺切除术中的应用。在此，我们报告一组经口内镜全甲状腺切除术前庭入路（TOETVA）在甲状腺良恶性疾病中成功应用的病例。2015年1月1日至2016年6月30日期间，我们对我院11例患有良性或恶性甲状腺结节的患者实施了TOETVA。所有术前诊断为结节性甲状腺肿的患者手术均成功完成。手术在全身麻醉下进行，平均手术时间为130分钟。平均失血量为2 - 3毫升。研究参与者未发生喉返神经损伤、颏神经损伤、甲状旁腺损伤或切口周围粘连。术后患者未出现可见瘢痕。患者术后恢复顺利，4天后出院。TOETVA在结节性甲状腺肿的手术治疗中安全有效，为传统手术提供了无瘢痕替代方案。
