Development of minimally invasive thyroid and parathyroid surgery

我们已经开发出用于内窥镜甲状腺切除术的腋窝和前胸入路。内窥镜手术的平均手术时间明显长于传统的开放手术。所有接受腋窝入路治疗的患者对美容效果均满意。内窥镜手术后的术后主诉发生率明显低于开腹手术。微创小切口手术在直视和内窥镜下进行，以最大限度地减少手术侵袭性，提高美容效果。我们的手术不同于传统的甲状腺切除术，它需要一个3厘米的皮肤切开，而且不需要掀起一块皮瓣。由于甲状腺切除术是在通过小皮肤切口取出甲状腺后进行的，因此可以获得足够的显露以剥离气管前和气管旁间隙。内窥镜甲状腺切除术是精挑细选的甲状腺疾病患者的首选手术。目前的适应证包括直径小于4 cm的良性滤泡性腺瘤、小于10 mm的低危乳头状癌、小于4 cm的嗜氧细胞瘤和术前超声所显示的Graves病。微创微创入路适用于低风险、高分化癌患者。如果肿瘤不大，可以行甲状腺全切除术和双侧改良颈淋巴清扫术。

We have developed axillary and anterior chest approaches for endoscopic thyroidectomy. The mean operating time for the endoscopic procedure was significantly longer than that for conventional open surgery. All patients who were treated using the axillary approach were satisfied with the cosmetic results. The incidence of postoperative complaints after endoscopic surgery is significantly lower than that after open surgery.The minimally invasive mini-incision approach has been performed under direct and endoscopic vision to minimize surgical invasiveness and improve cosmetic results. Our procedure differs from conventional thyroidectomy in requiring a 3-cm skin incision and in not raising of a skin flap. Since thyroidectomy is performed after extracting the thyroid gland through the small skin incision, sufficient exposure for dissection of the pretracheal and paratracheal space can be obtained.Endoscopic thyroidectomy is the procedure of choice in well selected patients with thyroid disease. The present indications for this procedure include benign follicular adenomas less than 4 cm in diameter, low-risk papillary carcinomas less than 10 mm, oxyphilic cell tumors less than 4 cm and Graves' disease as imaged on preoperative ultrasonography. The minimally invasive mini-incision approach is indicated for patients with low-risk, well differentiated carcinomas. Total thyroidectomy and bilateral modified neck dissection is possible, if the tumor is not large.