American Thyroid Association Statement on Remote-Access Thyroid Surgery
American Thyroid Association Statement on Remote-Access Thyroid Surgery
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DOI：
10.1089/thy.2015.0407
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发表时间：
2016-03-01
期刊：
影响因子：
6.6
通讯作者：
Terris, David J.
中科院分区：
文献类型：
--
作者：
Berber, Eren;Bernet, Victor;Terris, David J.
背景：近年来，远程访问技术被描述为一种不在颈部切开就可以切除甲状腺的方法。然而，在可用技术的数量和给定技术的理想患者选择标准方面存在混淆。这篇综述的目的是对这些方法进行简单的分类，描述最佳的患者选择标准，客观地评估结果，并确定采用的障碍。方法：对文献进行回顾，以确定所描述的技术。提出了一种简单的分类方法。描述了技术细节、结果和学习曲线。就患者选择和远程甲状腺手术的实施提出了专家意见共识。结果：远程甲状腺手术可分为内窥镜或机器人乳房手术、双侧腋窝乳房手术、腋窝手术和面部除皱术。美国的经验涉及后两种技术。文献中有限的数据表明，与传统甲状腺切除术相比，远程甲状腺手术的手术时间长，学习曲线陡峭，成本更高。然而，人们达成了共识，即在适当的情况下，对于希望避免颈部切开的单侧小结节患者来说，它可以是一个可行的选择。结论：远程甲状腺切除术在符合严格选择标准的一小部分患者中发挥了作用。这些方法需要更高水平的专业知识，因此应该由进行大容量甲状腺和机器人手术的外科医生完成。
Background: Remote-access techniques have been described over the recent years as a method of removing the thyroid gland without an incision in the neck. However, there is confusion related to the number of techniques available and the ideal patient selection criteria for a given technique. The aims of this review were to develop a simple classification of these approaches, describe the optimal patient selection criteria, evaluate the outcomes objectively, and define the barriers to adoption. Methods: A review of the literature was performed to identify the described techniques. A simple classification was developed. Technical details, outcomes, and the learning curve were described. Expert opinion consensus was formulated regarding recommendations for patient selection and performance of remote-access thyroid surgery. Results: Remote-access thyroid procedures can be categorized into endoscopic or robotic breast, bilateral axillo-breast, axillary, and facelift approaches. The experience in the United States involves the latter two techniques. The limited data in the literature suggest long operative times, a steep learning curve, and higher costs with remote-access thyroid surgery compared with conventional thyroidectomy. Nevertheless, a consensus was reached that, in appropriate hands, it can be a viable option for patients with unilateral small nodules who wish to avoid a neck incision. Conclusions: Remote-access thyroidectomy has a role in a small group of patients who fit strict selection criteria. These approaches require an additional level of expertise, and therefore should be done by surgeons performing a high volume of thyroid and robotic surgery.