Transoral access for endoscopic thyroid resection
Transoral access for endoscopic thyroid resection
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DOI：
10.1007/s00464-007-9734-6
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发表时间：
2008-08-01
影响因子：
3.1
通讯作者：
Stein, H. J.
中科院分区：
文献类型：
--
作者：
Witzel, K.;von Rahden, B. H. A.;Stein, H. J.
背景技术 越来越多的患者要求进行内窥镜颈部手术。腋窝、乳房和胸部入路的入路创伤比开放手术或视频辅助手术更大。作者测试了舌下经口入路的可行性，他们认为这是最有前途的从颈部外部进入甲状腺的微创内窥镜入路。方法首先在两具新鲜人类尸体上评估舌下经口入路。然后使用猪模型进行了实验研究。使用改良的带闭孔器的腋镜、超声剪刀和神经监测系统来识别喉返神经，对 10 头猪总共进行了 10 次内镜经口甲状腺切除术。结果对人类尸体和所有活猪均实现了完整的经口甲状腺切除术。尽管解剖区域很复杂，但经口手术的实施却非常容易。在动物研究中，从将闭塞器引入喉部上方到移除的时间为 59 秒。平均总手术时间为50分钟。神经监测系统可以在甲状腺切除后证实两侧喉返神经的正常功能。术后再观察猪2小时。术中及术后均未出现并发症。结论内镜下经口甲状腺切除术是可行的。事实证明，这对活猪来说是一种安全的手术，而且非常容易实施。正如本研究之前对人类尸体进行的甲状腺切除术所表明的那样，这些结果可能有助于使用类似的途径对人类进行甲状腺切除术。
Background Endoscopic neck surgery is requested by an increasing number of patients. The access trauma of the axillary, breast, and chest approaches is greater than with open or video-assisted surgery. The authors tested the feasibility of the sublingual transoral access, which they believe is the most promising minimally invasive endoscopic access to the thyroid gland from outside the neck region.Methods The sublingual transoral access was first evaluated in two fresh human cadavers. An experimental investigation then was performed using a porcine model. A total of 10 endoscopic transoral thyroidectomies were performed in 10 pigs using a modified axilloscope with an obturator, ultrasonic scissors, and a neuromonitoring system to identify the recurrent laryngeal nerve.Results A complete transoral thyroid resection was achieved with both the human cadavers and all the living pigs. Despite the complexity of the anatomic region, the transoral procedure was astonishingly easy to perform. In the animal study, the time from the introduction of the obturator just above the larynx to its removal was 59 s. The average overall operation time was 50 min. The neuromonitoring system permitted the regular function of the recurrent laryngeal nerves on both sides to be proved after removal of the thyroid gland. The pigs were observed for another 2 h after the operation. No complications occurred during the operation or afterward.Conclusions Endoscopic transoral thyroid resection is possible. It proved to be a safe procedure in living pigs and astonishingly easy to perform. The results may be helpful for thyroid resections in humans using a similar access, as suggested by the thyroidectomies in human cadavers preceding this study.