Endoscopic Thyroidectomy: A Literature Review and Update
Endoscopic Thyroidectomy: A Literature Review and Update
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内镜甲状腺切除术：文献回顾与更新
作者：
K. Wong;B. Lang
自1996年首次报道内窥镜甲状旁腺次全切除术以来，各种内窥镜手术方法已被报道。这些内窥镜手术入路包括微创电视辅助甲状腺切除术(MIVAT)、内窥镜外侧入路、外侧小切口入路、前胸(混合)入路、腋窝入路、腋下乳房入路、耳后腋窝入路和其他新的实验入路。其中一些方法可以在达芬奇机器人(即机器人辅助甲状腺切除术)的帮助下完成。为简化起见，这些入路可分为颈部/直接入路和宫颈外/间接入路。每种技术或方法都有自己的优点和缺点。目前，文献中没有首选的方法，选择似乎是由外科医生自己的经验和患者的偏好决定的。根据我们的经验，与MIVAT相比，腋窝入路在技术上更具挑战性，与MIVAT相比，住院时间更长，手术时间更长，疼痛更直接，喉返神经损伤和发病率更高。两种手术的6个月疤痕外观和患者满意度相似。
Since the first report of endoscopic subtotal parathyroidectomy in 1996, a variety of endoscopic surgical approaches has been reported. These endoscopic approaches include the minimally-invasive video-assisted thyroidectomy (MIVAT), the endoscopic lateral approach, the lateral mini-incision approach, the anterior/chest (hybrid) approach, the transaxillary approach, the axillo-breast approach, the post-auricular and axillary approach, and other novel experimental approaches. Some of these approaches could be done with the assistance of the da Vinci robot (i.e. robotic-assisted thyroidectomy). For simplification, these approaches could be categorized into the cervical/direct approach and the extra-cervical/indirect approach. Each technique or approach has its own benefits and weaknesses. Currently, there is no preferred approach in the literature and the choice seems to be determined by the surgeon’s own experience and the patient’s preference. In our experience, the transaxillary approach was a technically more challenging procedure and was associated with longer hospital stay, longer operating time, more immediate pain, and increased overall RLN injury and morbidity than MIVAT. The 6-month scar appearance and patient satisfaction were similar between the two procedures.