Robotic Facelift Thyroidectomy: Patient Selection and Technical Considerations
Robotic Facelift Thyroidectomy: Patient Selection and Technical Considerations
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DOI：
10.1097/sle.0b013e3182266dd6
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发表时间：
2011-08-01
影响因子：
1
通讯作者：
Seybt, Melanie W.
中科院分区：
文献类型：
--
作者：
Terris, David J.;Singer, Michael C.;Seybt, Melanie W.
目的：在过去的十年中，一系列远程进入甲状腺切除术技术，其中一些使用手术机器人。这些方法大多需要尴尬的定位，使用不熟悉的解剖平面，并伴有许多明显的并发症。因此，接受度受到限制。我们描述了最近描述的机器人甲状腺切除术（RFT）方法的技术细节和患者选择标准，以避免这些陷阱。设计：分析临床前和临床研究。方法：进行无生命和尸体解剖研究及临床应用。具有30度偏移基础位置的3臂RFT技术被证明是最佳的。仰卧位，双臂折叠，患者处于轻微的Trendelenburg位，有利于光学袋的剥离。已获得并考虑的人口统计学和外科数据包括患者年龄、性别、体重指数、病理和并发症。结果：在有限的患者群体中完成了一系列连续的RFT手术。所有病例均由机器人完成，无需转开手术。除了第一个病例外，所有病例都是在无排水的门诊基础上完成的。结论：在耳后折痕和枕部发际线上使用单一通道的无气RFT技术是可行的，在技术上比其他远程进入方法更具挑战性，并且安全。在扩大的患者群体和更多的大容量甲状腺中心进行进一步的研究是必要的。参见视频，补充数字内容1，http://links.lww.com/SLE/A36和补充数字内容2，http://links.lww.com/SLE/A37。
Objectives: A series of remote access thyroidectomy techniques, some using a surgical robot, have been introduced in the last decade. Most of these approaches require awkward positioning, use unfamiliar dissection planes, and have been associated with a number of significant complications. As a result, acceptance has been limited. We describe technical details and patient selection criteria of a recently described robotic facelift thyroidectomy (RFT) approach that avoids these pitfalls.Design: Analysis of preclinical and clinical studies.Methods: Inanimate and cadaver dissection studies and clinical implementation were pursued. A 3-arm RFT technique with a 30-degree offset base location proved optimal. Supine positioning with arms tucked and the patient in slight Trendelenburg position facilitated the dissection of the optical pocket. Demographic and surgical data that have been obtained and considered include patient age, sex, body mass index, pathology, and complications.Results: A series of consecutive RFT procedures has been accomplished in a limited population of patients. All cases were completed robotically with no conversions to open surgery necessary. All but the first case was accomplished on a drainless, outpatient basis.Conclusions: A RFT technique that is gasless and uses a single access port in the postauricular crease and occipital hairline location is feasible, technically less challenging than other remote access methods, and safe. Further study in an expanded patient population and in additional high-volume thyroid centers is warranted. See the videos, Supplemental Digital Content 1, http://links.lww.com/SLE/A36 and Supplemental Digital Content 2, http://links.lww.com/SLE/A37.