ABSTRACT
Introducción: Desde hace aproximadamente 20 años se han venido realizando varias técnicas de tiroidectomía por mínimo acceso, apoyadas en la videoendoscopia en pro de reemplazar la incisión clásica descrita por Kocher. Se han diseñado múltiples abordajes, sin embargo, ninguno ha conseguido evitar totalmente las cicatrices. En el año 2008 Witzel introdujo la técnica transoral y en el 2015, Anuwong publicó la primera serie realizada en humanos. Presentación del caso: Se trata de una paciente de 47 años a quien se ha diagnosticado por PAAF una lesión folicular en el lóbulo izquierdo de la tiroides. Discusión: La paciente fue sometida a hemitiroidectomía izquierda más estudio de congelación transoperatoria que resultó negativo. Se realizó un abordaje transoral endoscópico, con un tiempo de 280 min y sangrado de 40 ml. No se registraron complicaciones en el transoperatorio ni en el postoperatorio. Conclusión: La tiroidectomía transoral endoscópica por abordaje vestibular (TOETVA) representa, entre las cirugías de mínimo acceso, la única que potencialmente está totalmente libre de cicatrices, ofreciendo seguridad y resultados comparables con otras técnicas.
Introduction: For about 20 years we has been conducting several techniques of minimal access thyroidectomy, supported by videoendoscopy towards replacing the classic Kocher incision. Multiple approaches have been described, however none has achieved completely avoid scarring. Witzel in 2008 introduced the transoral technique and in 2015 Anuwong published the first series performed in humans. Case presentation: This is a 47 years old patient who have been diagnosed by FNAB follicular lesion in the left lobe of her thyroid. Discussion: The patient underwent a left hemithyroidectomy + intraoperative frozen study that was negative, transoral endoscopic approach was performed with a time of 280 min and 40 ml bleeding. No complications occurred intraoperatively or postoperatively. Conclusion: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) represents between the minimum access surgeries the only one that is potentially totally free of scars, offering safety and comparable results with other techniques.
Subject(s)
Humans , Female , Middle Aged , Natural Orifice Endoscopic Surgery , Thyroid Diseases/surgery , Thyroidectomy/methods , Video-Assisted Surgery , Minimally Invasive Surgical ProceduresABSTRACT
Objective To analyze the advantages and disadvantages of minimally invasive video -assisted thyroidectomy(MIVAT)and totally endoscopic thyroidectomy (TET).Methods The study included 70 patients undergoing MIVAT and TET at Qilu Hospital of Shandong University and Yantai Yuhuangding Hospital from Jan . 2012 to Dec.2012.46 patients undergoing MIVAT(MIVAT group)and 24 patients undergoing TET(TET group) were analyzed retrospectively .Data of gender,age,operative data,intraoperative and postoperative complications , length of stay , feelings of patients and cosmetic effect were collected and analyzed .MIVAT and TET were com-pared in terms of safety ,trauma and cosmetic effect .Results ①About safety:no permanent recurrent laryngeal nerve(RLN)palsy and parathyroid injury occurred in either group .One case in MIVAT group and no case in TET group was converted to open surgery (2.2%vs 0%,P>0.05) .②About trauma:the intraoperative blood loss and postoperative drainage amount in the MIVAT group were significantly less than those in the TET group ( P 0.05).③About cosmetic effect:the 2 groups had similar patient satisfaction index .Conclusions The study shows similar results in safety and trauma .The 2 approaches are both safe and valid .Patients using the two ap-proaches are equally satisfied with the cosmetic effect .
ABSTRACT
Objective To explore the efficiency of transcervical video-assisted mini-incision thyroidectomy for thyroid tumor. Methods 53 patients with thyroid tumors who underwent the video-assisted mini-incision thyroidectomy from Jan. 2006 to Dec. 2009 in the Department of Thyroid Surgery, Yantai Yuhuangding Hospital,were retrospectively studied. Results All of the patients, except 5 cases converting to open thyroidectomy, underwent the video-assisted mini-incision thyroidectomy successfully. The temporary recurrent laryngeal nerve injury occurred in 1 patients. The subcutaneous fluid accumulation occurred in 3 patients. The skin burns around the incisions occurred in 3 patients. There was no complication of hematoma, hypocalcemia, or superior laryngeal nerve injuries. The follow-up period was from 3 months to 35 months. There was no evidence of recurrence and metastasis by postoperative ultrasonic and CT scan and radioiodine scintigraphy. Conclusions The video-assisted mini-incision thyroidectomy is feasible, safe, and with the advantage of cosmetic results. For thyroid tumor,especially thyroid cancer, longer follow-up is necessary to draw definitive conclusion on recurrence and survival rate.
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Objective To explore the feasibility and efficiency of minimally invasive video-assisted thy-roidectomy on thyroid microcarcinoma, and sum up the experiences. Methods 9 patients with thyroid microcarci-noma who underwent the minimally invasive video-assisted thyroidectomy from Jan 2006 to Feb 2009, were retro-spectively studied. Results All of the patients, except 1 case converting to open thyroidectomy, underwent the minimally invasive video-assisted thyroidectomy successfully. The subcutaneous hydrops occurred in 1 patient. The skin burns around the incisions occurred in 1 patient. There were no complications of recurrent laryngeal nerve injuries, neck hematoma, hypocalcemia, or superior laryngeal nerve injuries. The follow-up period of 15 cases were from 3 months to 37 months. There were no evidences of recurrence and metastasis by both postopera-five ultrasonic/CT examination and radioiodine scintigraphy. Conclusions The minimally invasive video-assisted thyroidectomy is safe and feasible (similar to the traditional thyroidectomy), of gratifying cosmetic results, for low-risk differentiated thyroid microcarcinoma without lymph node metastasis. For the median-risk or high-risk, more patients, comparative studies and long follow-ups are necessary to draw definitive conclusions in terms of its recurrence and survival rate.
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Objective To study the safety, surrounding tissue injury and cervical wound appearance of the video-assisted thyroidectomy. Methods 230 patients had video-assisted thyroidectomy (group endoscopy) and 204 had conventional open thyroidectomy (group open). Operative duration, postoperative hospital stay, complications,cervical wound healing and appearance, and recurrence rate were compared. Results Operative duration and postoperative hospital stay were (33±29)min and (2±1)days for group endoscopy and (40±21)min and (5±2)days for group open (P=0.025, P=0.000) respectively. Cosmetic result of wound evaluated by numeric scale was in favor of group endoscopy (P=0.000). There were no significant differences in infection of incisional wound, between two groups (P=0.270). After 6-30 months' follow-up, the recurrence rate showed no difference between two groups(P=0.909). Conclusions Compared with conventional surgery, endoscopic thyroidectomy for thyroid diseases was a practical and safe procedure with excellent cosmetic benefits, short hospital stay and less postoperative complications.