内镜辅助的甲状腺切除术(附8例报告)

目的探讨内镜辅助甲状腺切除术的可行性.方法回顾性分析2002年9月～2004年9月我院8例甲状腺良性结节的患者,进行内镜辅助微创甲状腺腺叶切除的临床资料. 结果手术均获成功,手术时间90～150 min,平均120min.术中失血10～30ml,平均20 ml.无并发症,无中转手术.术后3～4 d均痊愈出院.8例随访6～12个月,平均9个月,伤口愈合良好,无感觉不适.结论内镜辅助的甲状腺切除术安全有效,并具有明显美容效果.     

内镜辅助下甲状旁腺手术

目的探索内镜辅助下甲状旁腺手术的可行性、安全性和效果。方法在颈部胸骨切迹上做一约2cm横切口，免充气，依靠拉钩提拉建立操作腔隙，内镜辅助下采用超声刀等手术器械分离切除病变甲状旁腺（3例无功能性甲状旁腺囊肿和7例甲状旁腺腺瘤伴甲状旁腺功能亢进症）。结果10例手术均获成功，无一例中转开放手术。手术时间；20～70min，平均40min。术后无声嘶、呛咳、出血，3例出现一过性低钙血症。10例随访2～18个月，平均9个月，血钙和甲状旁腺素正常，美容效果满意。结论内镜辅助下甲状旁腺手术微创、安全，具有手术时间短、恢复快和美容的优点。     

腔镜小切口甲状腺手术110例报告

目的：探讨内镜辅助下经颈部小切口行甲状腺切除术的可行性及手术效果。方法：内镜辅助下经颈部小切口为110例患者行甲状腺切除术。结果：成功完成手术105例,5例因术中病理为甲状腺癌中转开放手术。手术切口长1．5—2．5cm,平均2．1cm,手术时间30—90min,平均46min,术中出血3-10ml,平均5ml。术后住院1—3d,平均2．1d。无永久性声嘶、出血、低血钙等并发症发生,皮下积液6例,暂时性喉返神经损伤2例,切缘烧烫伤5例,术后瘢痕细小,效果满意。结论：临床上内镜辅助甲状腺手术安全可行,术后患者康复快,颈部美容效果好。     

内镜在甲状腺切除术的临床应用

目的 探讨应用内镜外科技术施行甲状腺手术的可行性及效果。方法 采用须部无瘢痕内镜甲状腺切除术(SET)和微创电视辅助甲状腺切除术(MIvA)。SET切口选择在乳晕上缘、胸骨旁，钝性游离胸前和颈前皮下腔隙，在内镜下行甲状腺肿瘤或腺体次全切除术。MIvA切口选择在胸骨切迹上1cm处长约3cm，在电视辅助下行甲状腺肿瘤或腺体次全切除术。结果 SETl0例和MIvAl2例全部手术成功，无并发症。术后恢复良好，无声嘶、呛咳，颈部水肿、隆起明显改善。结论 对甲状腺切除手术，SET具有明显的美容效果，MIVA是一种微创和有效方法。     

内镜甲状腺切除术的手术要点

目的：探讨应用内镜外科技术施行甲状腺手术的可行性及手术要点。方法：采用颈部无疤痕内镜甲状腺切除术(SET)和微创电视辅助甲状腺切除术(MIVA)。SET切口选择在乳晕上缘、胸骨旁，钝性游离胸前和颈前皮下腔隙，在内镜下行甲状腺肿瘤切除或腺体次全切除术。MIVA切口选择在胸骨切迹上1cm处，长约3cm，在电视辅助下行甲状腺肿瘤切除或腺体次全切除术。结果SET、12例和MIVA 12例全部手术成功，术后恢复良好，无声嘶、呛咳等并发症，颈部水肿隆起明显改善。结论：内镜下甲状腺切除术是可行的，SET具有明显的美容效果，MIVA是一种微创和有效的方法，手术应由有内镜外科经验的医师进行，关键在于良好的显露和止血。     

腹腔镜辅助颈入路甲状腺手术

目的探讨腹腔镜辅助下甲状腺手术的可行性及安全性. 方法胸骨切迹上1.0 cm横形切口2.0 cm,5 mm腹腔镜下使用超声刀,用"凝-分-吸"和"分-凝-断"2种方法处理腺体和血管,完成腺体摘除或腺叶切除. 结果甲状腺腺瘤(结节)摘除术20例,单侧甲状腺腺叶切除术6例.手术时间80～130 min,平均100 min.术中出血量10～40 ml,平均20 ml.未出现手术并发症.23例随访1～20个月,平均9个月,病人对颈部美容满意,无复发. 结论内镜辅助下甲状腺手术安全可靠,与传统手术相比具有切口小、创伤小、美容的优点.     

乳晕入路腔镜下甲状腺切除术18例报告

目的探讨乳晕切口入路腔镜下甲状腺手术的可行性和美容效果。方法2004年1月～2006年1月，经胸乳晕入路腔镜下行甲状腺良性肿物切除术18例。于右乳晕边缘1点处弧形切口长5mm置抓钳，左乳晕边缘11点处弧形切口长12mm置超声刀，乳沟中央做10mm水平切口置腔镜。通过分离胸前皮下和颈阔肌深面，注入c0：5mmHg建立手术空间。超声刀切割、分离甲状腺组织和甲状腺血管。结果18例手术均成功，其中12例甲状腺瘤切除术，1例甲状腺部分切除术，5例双侧甲状腺大部分切除术。单侧手术时间45～120min，平均62min；术中出血量6～20ml，平均11ml。双侧手术时间90～180min，平均98min；术中出血量15～70ml，平均29．5ml。术后住院3～5d。术后无严重并发症。18例随访6～12个月，平均9个月，切口愈合良好，无瘢痕，无复发。结论乳晕入路腔镜下甲状腺手术安全、可行，颈部美容效果好。     

腔镜辅助甲状腺肿瘤微创手术150例临床分析

探讨腔镜辅助下颈部小切口甲状腺肿瘤微创手术的技巧。回顾性分析150例腔镜辅助下颈部小切口甲状腺肿瘤微创手术的临床资料。其中良性病变108例,甲状腺乳头癌42例。150例均顺利完成手术,前50例平均手术时间80±15 min,术中出血量30~80 m L,术后引流25~50 m L。后100例平均手术时间50±13 min,术中出血量20~35 m L,术后引流量10~30 m L。切口长2~3 cm,术后2 d出院,均未发生并发症。对于有适应证的甲状腺肿瘤,腔镜辅助下颈部小切口手术具有安全可靠、美容效果明显等优点。     

Miccoli法甲状腺切除术

目的探讨在腹腔镜辅助下用超声刀行甲状腺切除术的可行性及优越性.方法对14例病人在腹腔镜下使用超声刀自颈部小切口行部分或次全甲状腺切除术.结果14例均完成手术.无一例中转手术.手术时间30～70min,平均45 min.术后病理报告均为结节性甲状腺肿.全组病例术后恢复良好,无切口感染及积液,颈部切口仅为2.5cm左右.14例随访3～17个月,均对瘢痕效果满意.结论Miccolli法甲状腺切除术具有操作简单,美容效果明显等优点.     

改良Miccoli术式内镜下甲状腺手术667例分析

目的 探讨腔镜辅助下颈部小切口甲状腺手术（Miccoli 术式）中的技巧,总结手术各项指标及相关经验。方法 回顾性分析2006年6月至2010年4月吉林大学第一医院甲状腺外科667例腔镜辅助下颈部小切口行甲状腺手术的临床资料。 结果 667例均顺利完成腔镜辅助甲状腺手术。前50例手术平均时间（60±13）min;后617例平均（39±9）min。术中出血量15～80mL,术后引流量5～35mL,均于第2天拔除引流管。术后住院时间（3±1）d。手术切口长2.0～2.5cm。术后均未使用止痛药, 出现暂时性声嘶1例,皮下气肿1例,中转开放手术10例。所有病例均未发生术后出血或感染。全组随访3~12个月,无一例复发。结论 腔镜辅助下颈部小切口甲状腺手术安全可靠、并发症少且美容效果相对较好,在掌握一定技巧的基础上实施,临床效果更佳,应用前景广阔。     

经乳晕单孔腔镜甲状腺手术13例报告

目的探讨经乳晕途径单孔腔镜甲状腺手术的可行性、安全性及优势。方法通过单侧乳晕切口建立皮下操作空间,置入腔镜和一个操作器械,应用颈部缝线悬吊技术显露甲状腺,超声刀切离患侧甲状腺。结果 13例手术均顺利完成,未中转三孔腔镜手术或开放手术,8例行甲状腺次全切除术,5例行甲状腺部分切除术。手术时间145～205 min,平均170 min;术中出血量15～40 ml,平均25 ml;术后创面引流总量80～135 ml,平均115 ml,术后3～4 d拔管;术后24 h疼痛视觉模拟评分为1～5分,平均3.2分。术后病理:7例甲状腺腺瘤,6例结节性甲状腺肿。13例术后3个月随访,无明显胸壁创面疼痛、麻木,无颈胸皮肤发紧不适感,患者对美容效果评分(0分为非常不满意,10分为非常满意)为8～10分,平均9.5分。结论经乳晕单孔腔镜甲状腺手术安全可行,具有切口隐蔽、皮下分离面积小、美容满意度高等特点。     

Video-assisted thyroidectomy: report of a 7-year experience in Rome

Background and aims We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-year period.Materials and methods VAT is a gasless procedure performed under endoscopic vision through a single 1×5×2.0-cm skin incision. The eligibility criteria are thyroid nodules ≤35 mm, thyroid volume <30 ml, and no previous conventional neck surgery. Small, low-risk papillary thyroid carcinomas (PTC) were considered eligible.Results There were 521 VATs attempted. Conversion was necessary six times (difficult dissection in one case, large nodule size in three, and gross lymph node metastases in two). Thyroid lobectomy was successfully accomplished in 113 cases, total thyroidectomy in 398, and completion thyroidectomy in 14. In 66 patients, the central neck nodes were removed through the same access. Pathology showed benign diseases in 313 cases, PTC in 187, and medullary microcarcinoma in 1. Postoperative complications included 9 transient recurrent nerve palsies, 73 transient hypocalcemias, 3 definitive hypoparathyroidisms, 1 postoperative haematoma, and 2 wound infections. The cosmetic result was excellent. In patients with PTC, no evidence of recurrent disease was shown.Conclusions The indications for VAT are still limited. Nonetheless, in selected patients, it seems a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.Presented at the International Symposium “Modern Technologies in Thyroid Surgery”, 10–11 February 2006, Halle/Saale, Germany     

Endoscopic thyroidectomy for solitary nodules

INTRODUCTION: The aim of this study was to assess the feasibility and safety of endoscopic thyroidectomy. MATERIALS AND METHODS: Between September 1998 and February 2000, 18 patients with a solitary thyroid nodule underwent endoscopic thyroidectomy in a single institution. Analgesic requirement, return to normal activity, and cosmetic results were compared to 18 consecutive patients who had conventional thyroidectomy. RESULTS: Sixteen females and two males, with a mean age of 43 years (17-66 years) were operated on. Indications for surgery included indeterminate cytology (n = 8), follicular neoplasm (n = 8), Hürthle cell neoplasm (n = 1), and toxic thyroid nodule (n = 1). The mean nodule diameter was 2.7 cm (0.6-7 cm). Sixteen of 18 cases were successfully completed endoscopically with a mean operating time of 220 min (120-330 min). There were no major complication, but three patients developed mild hypercarbia and one patient had an incidental parathyroidectomy. When compared to conventional thyroidectomy, patients undergoing endoscopic thyroidectomy had a significantly superior cosmetic result (P < 0.005) and a quicker return to normal activity (P < 0.05), but there was no difference in analgesic requirement. CONCLUSION: The results of this study seem to confirm that endoscopic thyroidectomy is a technically feasible and safe procedure that leads to an improved cosmetic result and a quicker recovery. However, conventional thyroidectomy is still recommended when thyroid carcinoma is suspected.     

Gasless single incision endoscopic thyroidectomy

Background:

Endoscopic thyroidectomy making the scar outside the neck area has a cosmetic appeal for patients. Based on an anterior chest wall approach combined with the gasless technique, we developed a novel method for gasless endoscopic thyroidectomy with a single incision.

Materials and Methods:

From March 2009 to November 2010, 48 patients with benign thyroid nodules underwent thyroidectomy with the gasless single-incision endoscopic surgery technique via the anterior chest wall approach. A 3-cm long skin incision parallel to the clavicle was made on the anterior chest wall on the side of the lesion. The platysma flap was lifted up to maintain working space from the incision to the thyroid cartilage. Dissection of the thyroid was begun from the inferior pole of the thyroid. The line of resection was selected to preserve recurrent laryngeal nerve and parathyroids. A 5-mm drainage tube was inserted into the lower portion of the operative space through the incision after the thyroid gland and the lesion were resected using the Harmonic scalpel.

Results:

The overall operating time was 126 minutes (range, 90 to 210), 138 minutes (range, 80 to 160) in first 24 cases; and 112 minutes in the second 24 patients (P<.05). Three cases were converted to the conventional procedure: 2 because of a malignancy diagnosed on frozen section, and one due to uncontrolled bleeding from the middle thyroid vein. Another malignancy diagnosed on final pathological examination was treated with additional surgery to complete the thyroidectomy by using the conventional open method. There were 2 cases of postoperative complications: transient hoarseness and hematoma. No wound infection occurred in our series. The scar was well hidden beneath the clothes, and the patients were satisfied with the cosmetic result of the surgery.

Conclusions:

Advantages of the chest wall approach combined with the gasless technique have made single-incision endoscopic thyroidectomy more feasible and practicable.     

Minimally invasive video-assisted thyroid resection (MIVAT)--a well accepted operative procedure

INTRODUCTION: We report on our results of MIVAT operations. METHOD: Nineteen Patients including 15 females and 4 males were operated with MIVAT, corresponding to 11 % of all patients undergoing an operation for benign goitre in our hospital. A single node of the thyroid gland within 30 mm and enlargement of a thyroid lobe up to 25 ml were the selection criteria. The median age was 34 years (range 16-61). We performed 2 thyroidectomies, 6 Hartley-Dunhill resections, 9 hemihyroidectomies and 2 enucleations. Eighteen patients (95 %) were followed-up postoperatively. The median follow-up period was 8 months (range 1 -21). RESULTS: The median operation time was 83 min (range 60-124). The median preoperative thyroid gland volume was 25 ml (range 10-54) measured by ultrasound. The resected thyroid tissue ranged from 12 to 51 g (median 29 g). A statistical significant difference (P = 0.04 paired t-test) between the preoperative and postoperative estimated serum-calcium levels (2.31 vs. 2.25 mM) was observed. But both parameters were inside the physiological range. Paresis of the recurrent laryngeal nerve was not observed. 89 % of the patients rated the postoperative cosmetic result as very good and all patients would prefer this operation procedure once again. CONCLUSION: The MIVAT procedure is a safe operation also in small groups with excellent cosmetic results postoperatively and a high acceptance by the patients.     

完全腔镜下甲状腺乳头状癌根治术的临床应用价值

目的:探讨完全腔镜下甲状腺乳头状癌根治术的临床应用效果及安全性。方法:选择2010年5月至2015年7月收治的70例确诊为甲状腺乳头状癌并行手术治疗的患者作为研究对象,其中腔镜组33例,开放手术组37例。对比分析两组患者围手术期资料、临床疗效及并发症情况。结果:腔镜组患者术中出血量、引流量、切口长度、术后24 h疼痛评分均显著低于开放组(P0.05),手术时间、术后3个月美容评分均显著高于开放组(P0.05),两组清扫淋巴结数量、总并发症发生率差异均无统计学意义(P0.05)。结论:完全腔镜下甲状腺乳头状癌根治术安全、美观、疗效确切,但手术时间明显延长。     

Minimally invasive video-assisted thyreoidectomy (MIVAT) with and without use of harmonic scalpel—a randomized study

BACKGROUND AND AIMS: Minimally invasive video-assisted thyroidectomy (MIVAT) has been used for the removal of small thyroid nodules to improve cosmetic results and diminish pain. The aim of this study was to compare the outcomes of the MIVAT operations with and without the use of an ultrasonic harmonic scalpel (HS). PATIENTS AND METHODS: Seventy-six patients with a solitary thyroid nodule below 30 mm in diameter were randomized to two groups of 38 patients each. Unilateral thyroid lobectomy was performed in each patient. In the clip-ligation group (CL-G), during MIVAT, the superior thyroid vessels were clipped and bipolar coagulation was used to secure smaller vessels, whereas in the harmonic scalpel group (HS-G), HS was used to dissect and divide all the thyroid vessels. The statistical analysis included the mean operative time, blood loss, postoperative morbidity, scar length, cosmetic satisfaction at 1 and 6 months following surgery, and cost-effectiveness. RESULTS: HS-G vs CL-G operations were shorter (31.4 +/- 7.7 vs 47.5 +/- 13.2 min; p < 0.001), the mean blood loss was smaller (12.9 +/- 5.7 vs 32.8 +/- 13.0 ml; p < 0.001), the mean scar length at 1 month following surgery was shorter (15.6 +/- 1.4 vs 21.5 +/- 1.9 mm; p < 0.001), and greater cosmetic satisfaction was achieved at 1 month after surgery (88.9 +/- 9.7 vs 81.9 +/- 5.4 pts; p < 0.001), but the difference became nonsignificant at 6 months postoperatively. MIVAT with HS was 20-30 euros more expensive. No major complications were observed in both groups. CONCLUSIONS: HS in the MIVAT operations is safe and facilitates dissection, allowing for a significant decrease in operative time. Other benefits, such as lower blood loss, a scar a few millimeters shorter, or a slightly better early cosmetic result, are offered at slightly increased costs.     

Safety of video-assisted thyroidectomy versus conventional surgery

BACKGROUND: Thyroid gland manipulation, surgical stress response, and postoperative outcome in cases of video-assisted thyroidectomy (VAT) and conventional thyroidectomy were compared to verify the safety of VAT. METHODS: Twenty consenting patients were randomly assigned to undergo VAT or conventional thyroidectomy. Serum thyroglobulin levels were monitored as indicators of thyroid manipulation, and C-reactive protein and white blood cell count were monitored to assess surgical stress response. Thyroid capsule integrity and the presence of spilled cells in the thyroid bed were verified. RESULTS: No significant differences were found in the indicators of thyroid gland manipulation and surgical stress response between groups. No thyroid capsules ruptured, and no spilled thyroid cells were found. Patients who had VAT experienced less pain, required fewer analgesics, and were more satisfied with the cosmetic result and the surgical outcome. CONCLUSIONS: VAT is as safe as conventional thyroidectomy and is characterized by a less painful postoperative course and by better cosmetic results and postoperative outcome.     

Minimally invasive nonendoscopic thyroidectomy.

OBJECTIVES: Minimal-access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a minimally invasive approach (MIT). STUDY DESIGN: Between October 2002 and December 2004, a prospective nonrandomized study of patients undergoing thyroid surgery was performed to evaluate the variables that might condition the indications to minimally invasive nonendoscopic approach. RESULTS: 296 patients underwent thyroid surgery; 46 of these were eligible for MIT through a 2.5- to 3-cm incision. There was one case of transient inferior laryngeal nerve palsy and no postoperative definitive hypoparathyroidism. MIT was converted to conventional thyroidectomy only in two cases. Cosmetic results were considered excellent by all patients. CONCLUSIONS: Minimal-access thyroid surgery is a safe and feasible alternative to conventional thyroid surgery in selected cases. The advantage that this technique offers, in addition to low morbidity, is an improved cosmetic result.     

Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer

Appropriate surgery in women with retroareolar breast cancer should allow resection of the cancer with wide free margins and an acceptable cosmetic result. The aim of this study was to compare breast conservation surgery (BCS) to mastectomy for treatment of retroareolar breast cancer. In a prospective nonrandomized study, 69 women with retroareolar breast cancers underwent either central quadrantectomy (n=33) with complete removal of the nipple-areola complex or mastectomy (n=36). Two of 33 (6%) patients scheduled for BCS had a secondary mastectomy and immediate reconstruction due to involved margins. After a median follow-up of 42 month (range 17-99 months) in the BCS group and 43 months (range 16-118 months) in the mastectomy group local and regional recurrences as well as systemic disease were comparable between both groups. The postoperative cosmetic result after BCS as evaluated by the patients was rated as excellent in 80% and good in 20% with no poor result. BCS followed by radiation therapy is a feasible alternative to mastectomy in patients with retroareolar breast cancer.