Department of Surgery, International Goodwill Hospital, 1-28-1 Nishigaoka, Izumi-ku, Yokohama, Kanagawa, 245-0006, Japan.
Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Langenbecks Arch Surg. 2022 Aug;407(5):2169-2175. doi: 10.1007/s00423-022-02579-5. Epub 2022 Jun 11.
After our group described the first remote-access thyroidectomy series in 2000, the procedure has been further developed. Although a thoracoscopic approach with a conventional open cervical incision for thyroid goiters with mediastinal extension has been performed at many institutions, remote-access thyroidectomy for cervicomediastinal goiters has not been established. We have performed combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomies (axillo-thoracic endoscopic thyroidectomies). Here, we describe a novel technique for performing a remote-access thyroidectomy for a cervicomediastinal goiter (CMG).
The patients with CMGs who agreed to an axillo-thoracic endoscopic thyroidectomy at one of two hospitals in Japan underwent a remote-access thyroidectomy.
We performed the axillo-thoracic endoscopic right or left hemithyroidectomy successfully, but most of the patients did not require the thoracoscopic procedure. None of the patients had complications, and none was converted to an open thyroidectomy.
Most thyroid goiters with substernal extension can be removed by the axillary approach, but some cases require a thoracoscopic approach. The novel approach described herein (axillo-thoracic endoscopic thyroidectomy) enables the safe excision of a CMG with high patient satisfaction for selected patients.
在我们小组于 2000 年描述了首例远程访问甲状腺切除术系列之后，该手术得到了进一步发展。尽管许多机构已经进行了经胸腔镜入路联合传统开放颈部切口用于治疗纵隔延伸性甲状腺肿的手术，但尚未建立用于治疗颈纵隔肿的远程访问甲状腺切除术。我们已经进行了联合胸腔镜和腋窝皮下内镜甲状腺切除术（腋窝-胸腔内镜甲状腺切除术）。在这里，我们描述了一种用于治疗颈纵隔肿（CMG）的新型远程访问甲状腺切除术技术。
在日本的两家医院中，同意进行腋窝-胸腔内镜甲状腺切除术的 CMG 患者接受了远程访问甲状腺切除术。
我们成功地进行了腋窝-胸腔内镜右侧或左侧半甲状腺切除术，但大多数患者不需要胸腔镜手术。没有患者出现并发症，也没有患者转为开放性甲状腺切除术。
大多数胸骨后延伸的甲状腺肿可以通过腋窝入路切除，但有些病例需要胸腔镜入路。本文描述的新方法（腋窝-胸腔内镜甲状腺切除术）可使选定患者安全切除 CMG，获得较高的患者满意度。
