"Scarless" (in the neck) endoscopic thyroidectomy (SET): An evidence-based review of published techniques
"Scarless" (in the neck) endoscopic thyroidectomy (SET): An evidence-based review of published techniques
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DOI：
10.1007/s00268-008-9555-3
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发表时间：
2008-07-01
影响因子：
2.6
通讯作者：
Delbridge, Leigh
中科院分区：
文献类型：
--
作者：
Tan, Charles T. K.;Cheah, W. K.;Delbridge, Leigh
背景：经颈前皮肤折痕切口行甲状腺切除术，可提供良好的直接暴露，便于安全解剖，手术快速，发病率低，死亡率低。然而，这些患者的颈部仍然有疤痕。技术创新使外科医生能够从远处切除甲状腺，在颈部提供无疤痕的结果。本研究的目的是评估不同的技术无瘢痕（在颈部）内镜甲状腺切除术（SET）通过审查目前的literature.Methods计算机辅助检索的Medline数据库，到2007年9月进行。使用的术语组合包括：内窥镜甲状腺切除术;微创甲状腺切除术;微创内分泌手术;经腋路甲状腺切除术;经前路甲状腺切除术;经乳房入路甲状腺切除术。根据以前未发表的经验，我们自己的单位与SET.Results有7项研究，涉及186例甲状腺切除术通过腋法和5个发表的系列，涉及169例甲状腺切除术通过前入路进行。有四个发表的系列甲状腺切除术通过混合方法，这是一个结合了前和腋入路，涉及180例患者。4项研究比较了SET和另一种甲状腺切除术入路。在我们未发表的SET系列中，我们在2年内进行了20例手术，其中11例经腋窝入路，9例经前/乳房入路。19例为肺叶切除术，1例为峡部切除术。SET与手术时间延长和术后疼痛增加相关。SET的患者满意的美学outcome of the procedure.Conclusion无瘢痕（在颈部）腔镜甲状腺切除术是不是一种微创技术，但最大限度地侵入性，涉及较长的手术时间和更大的术后疼痛。它所提供的是一个安全的切除甲状腺病理与没有疤痕的颈部。然而，有一个陡峭的学习曲线。随着经验的积累和手术器械的更新，手术时间和术后疼痛可能会减少。
Background Excision of the thyroid through a skin crease incision in the anterior neck provides good direct exposure to facilitate safe dissection and a quick operation with low morbidity and minimal mortality. However, these patients still have a scar in the neck. Technologic innovations have allowed surgeons to remove the thyroid gland from a remote site, providing a scarless outcome in the neck. This study was designed to assess the different techniques of scarless (in the neck) endoscopic thyroidectomy (SET) by reviewing the current literature.Methods A computer-assisted search of the Medline database through September 2007 was undertaken. The combination of terms used included the following: endoscopic thyroidectomy; minimally invasive thyroidectomy; minimally invasive endocrine surgery; thyroidectomy via the axillary approach; thyroidectomy via the anterior approach; and thyroidectomy via the breast approach. Additional data were provided based on previously unpublished experience from our own unit with SET.Results There were seven studies that involved 186 patients in whom the thyroid was excised via the axillary method and five published series that involved 169 patients who had thyroidectomies performed via the anterior approach. There were four published series of thyroidectomies performed via a hybrid approach, which is a combination of both the anterior and axillary approach, involving 180 patients. Four studies compared SET and another approach for a thyroidectomy. In our unpublished series of SET, we performed 20 cases during a 2-year period comprising 11 cases via the axillary approach and 9 cases via the anterior/breast approach. Nineteen cases were lobectomies and one case was an isthmusectomy. SET was associated with a longer operative time and increase postoperative pain. Patients who had SET were satisfied with the aesthetic outcome of the procedure.Conclusion Scarless (in the neck) endoscopic thyroidectomy is not a minimally invasive technique but a maximally invasive one that involves a longer operative time and greater postoperative pain. What it does provide is a safe excision of the thyroid pathology with the absence of a scar in the neck. However, there is a steep learning curve. With experience and newer surgical instruments, the operative time and postoperative pain might decrease.