Development of minimally invasive thyroid and parathyroid surgery

我们已经开发了腋窝和前胸入路用于内窥镜甲状腺切除术。内窥镜手术的平均手术时间明显长于传统的开放手术。所有采用腋窝入路的患者均满意其美容效果。内镜手术后的术后投诉发生率明显低于开放手术。微创小切口手术是在直视和内窥镜下进行的，以减少手术的侵入性并改善美容效果。我们的手术与传统甲状腺切除术的不同之处在于需要一个3厘米的皮肤切口，并且不需要抬高皮瓣。由于甲状腺切除术是在皮肤小切口取出甲状腺后进行的，因此可以获得足够的暴露来剥离气管前和气管旁间隙。内镜下甲状腺切除术是甲状腺疾病患者的首选手术方法。目前该手术的适应症包括直径小于4cm的良性滤泡腺瘤、小于10mm的低危乳头状癌、小于4cm的嗜氧细胞瘤和术前超声检查的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，可以行甲状腺全切除术和双侧改良颈部清扫术。

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.