Development of minimally invasive thyroid and parathyroid surgery

我们已经发展了腋路和前胸路的腔镜甲状腺切除术。内镜手术的平均手术时间明显长于传统开放手术。所有采用腋窝入路治疗的患者均对美容效果感到满意。内窥镜手术后的术后投诉发生率明显低于开放手术，微创小切口入路一直在直视和内窥镜下进行，以最大限度地减少手术创伤，提高美容效果。我们的手术与传统的甲状腺切除术不同，需要一个3厘米的皮肤切口，而不是提高皮瓣。由于甲状腺切除术是在通过小的皮肤切口取出甲状腺后进行的，因此可以获得足够的暴露以分离气管前和气管旁间隙。内窥镜甲状腺切除术是精心选择的甲状腺疾病患者的首选手术。目前该手术的适应症包括直径小于4 cm的良性滤泡性腺瘤、小于10 mm的低风险乳头状癌、小于4 cm的嗜酸性细胞肿瘤和术前超声成像的Graves病。微创小切口入路适用于低风险、高分化癌患者。如果肿瘤不大，甲状腺全切除术和双侧改良颈淋巴清扫术是可能的。

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.