Trans-Oral Video-Assisted Neck Surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach.
Trans-Oral Video-Assisted Neck Surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach.
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DOI：
10.1007/s00464-012-2588-6
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发表时间：
2013-04
影响因子：
3.1
通讯作者：
Natsugoe, Shoji
中科院分区：
文献类型：
--
作者：
Nakajo, Akihiro;Arima, Hideo;Hirata, Munetsugu;Mizoguchi, Tadao;Kijima, Yuko;Mori, Shinichiro;Ishigami, Sumiya;Ueno, Shinichi;Yoshinaka, Heiji;Natsugoe, Shoji
关键词：
腔镜甲状腺切除术是一种成熟的外科技术。我们一直在使用心前区视频辅助颈部手术（VANS），采用无气体前颈部皮肤提升方法。最近，自然腔道经腔内镜手术（NOTES）作为潜在的无疤痕手术在外科医生中引起了兴奋。我们开发了一种创新的无气体经口技术，用于内窥镜甲状腺切除术，该技术将NOTES的概念纳入VANS技术中。在下唇下方的前庭处进行切口。从前庭到颈前区，在下颌骨前方创建一个颈阔肌下隧道，通过克氏针和机械牵开系统提起颈部皮肤。该方法无需CO2吹入，创造了有效的工作空间，并提供了良好的头尾位视图，因此我们可以安全地进行甲状腺切除术和中央淋巴结清扫。从2009年9月TOVANS的首次临床应用开始，我们已经进行了8次这样的手术。8例患者中有3例患有乳头状微小癌，并在甲状腺切除术后接受了中央淋巴结清扫术。所有患者术后1天开始口服。所有患者术后颏部感觉障碍持续6个月以上。喉返神经麻痹1例。所有患者均未出现精神神经麻痹，使用预防性抗菌药物片3天后未发生感染。我们发展了一种新的方法，无气体经口内镜甲状腺切除术与下颌骨前的途径和前颈部皮肤提升。TOVANS使乳头状甲状腺癌的完全内镜根治性淋巴结切除术成为可能。我们认为，这种方法是创新和进步的，不仅具有美容优势，而且还提供了方便的进入中央淋巴结间室的内窥镜甲状腺癌手术的解剖。
Endoscopic thyroidectomy is a well-established surgical technique. We have been utilizing precordial video-assisted neck surgery (VANS) with a gasless anterior neck skin lifting method. Recently, natural orifice transluminal endoscopic surgery (NOTES) has generated excitement among surgeons as potentially scar-free surgery. We developed an innovative gasless transoral technique for endoscopic thyroidectomy that incorporated the concept of NOTES in a VANS-technique. Incision was made at the vestibulum under the inferior lip. From the vestibulum to the anterior cervical region, a subplatysmal tunnel in front of the mandible was created and cervical skin was lifted by Kirschner wires and a mechanical retracting system. This method without CO2 insufflation created an effective working space and provided an excellent cranio-caudal view so that we could perform thyroidectomy and central node dissection safely. Beginning with our first clinical application of TOVANS in September 2009, we have performed eight such procedures. Three of the eight patients had papillary microcarcinoma and received central node dissection after thyroidectomy. All patients began oral intake 1 day after surgery. The sensory disorder around the chin persisted more than 6 months after surgery in all patients. Recurrent laryngeal nerve palsy revealed in one patient. Nobody had mental nerve palsy, and no infection developed with use of preventive antibacterial tablets for 3 days. We developed a new method for gasless transoral endoscopic thyroidectomy with a premandible approach and anterior neck-skin lifting. TOVANS makes possible complete endoscopic radical lymphadenectomy for papillary thyroid cancer. We believe that this method is innovative and progressive and has not only a cosmetic advantage but also provides easy access to the central node compartment for dissection in endoscopic thyroid cancer surgery.
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影响因子：
5.2
作者：
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通讯作者：
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DOI：
10.1007/s00464-009-0347-0
发表时间：
2009-05-01
影响因子：
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DOI：
10.1007/s00464-007-9734-6
发表时间：
2008-08-01
影响因子：
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作者：
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通讯作者：
Stein, H. J.
影响因子：
5.2
作者：
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